Wide local excision surgery combined with 5-aminolaevulinic acid photodynamic therapy for Paget's disease of the scrotum in elderly people

Objective To investigate the safety and efficacy of wide local excision surgery combined with 5-aminolaevulinic acid(ALA)-photodynamic therapy(PDT)in treating Paget's disease of the scrotum in elderly people. Methods Patients with an average age of 68.4±4.7 years undergoing wide local excision surgery combined with ALA-PDT for Paget's disease of the scrotum from June 2014 to February 2018 were followed up.All patients underwent wide local excision surgical treatment first and were then enrolled in ALA-PDT study after the diagnosis of Paget's disease of the scrotum was confirmed.Four cases were eliminated as a result of two patients refusing photodynamic therapy for various reasons and two patients lost during follow-up after ALA-PDT.A total of 16 patients were included in the study, of whom 6 cases were in Ray stage A1, 7 cases in stage A2 and 3 cases in stage B. Patients underwent 3 courses of ALA-PDT after operation.Then the efficacy, short- and medium-term complications were followed up. Results The duration of disease among the 16 patients ranged from 4 to 76 months before diagnosis, with an average of 35.7 months.Surgery was performed immediately after diagnosis.Ten patients underwent resection and suture and 6 patients were treated with skin flap transfers.Of the patients treated with surgery, 3 patients received suspicious lymph node dissection and 1 patient underwent reoperation due to skin flap necrosis.Patients were followed up for 3 months to 3 years and 6 months after ALA-PDT.Recurrence and distant metastasis occurred in 2 cases, with 1 case of brain metastasis and 1 case of systemic metastasis, and the overall recurrence rate was 12.5%.During the follow-up, there were no other serious complications except for 1 case(6.3%)with lower limb movement disorders. Conclusions Wide local excision surgery combined ALA-PDT has good clinical outcomes, low recurrence rates and few complications for the treatment of Paget's disease of the scrotum in elderly people. Key words: Paget's disease of the scrotum; Local excision surgery; Photodynamic therapy