Sex Differences in Initial Treatment for Genital Extramammary Paget’s Disease in the United States: A Systematic Review

Abstract Background Surgery is the standard treatment for genital extramammary Paget’s disease (gEMPD). Objective To determine if gEMPD treatments and outcomes differ by sex and United States (US) region. Methods A systematic review was performed of all English-language studies on initial gEMPD treatment in MEDLINE via PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov . At least two reviewers performed title/abstract review and data extraction. Surgical categories included total skinning procedure (TSP), partial skinning procedure, Mohs micrographic surgery (MMS), or unspecified surgery. Chi-square tests of association were used for comparisons. Results 60 studies comprising 302 (79.7%) females and 77 (20.3%) males met criteria. Females were most often initially recommended partial skinning procedures. Seventy-four (24.5%) women and 0 men underwent total skinning procedures. Males were more likely to be offered MMS than females (40.3% vs. 1.9%, P Limitations Only twenty states were represented. Conclusion Females are more frequently offered TSP for gEMPD while males are more frequently offered MMS. MMS offers less recurrence and morbidity than TSP and should be recommended equally to both females and males with gEMPD.