Genital Paget's disease.

Paget's disease, mammary and extramammary, has been the subject of controversy for more than 4 score years. The meticulous study of Bennett 1 has demonstrated that Paget's disease of the nipple is always associated with an adenocarcinoma in the underlying breast. No such comprehensive investigation has been done on extramammary Paget's disease. This condition is most commonly seen in the genital, perianal, and axillary regions. Two entities have been described. Some patients have a primary carcinoma of an underlying organ (anal canal, prostate) 2 with lymphatic extension of the tumor to the epidermis. In the other type, which this paper will discuss, there is no underlying carcinoma. At present there are 2 hypotheses regarding pathogenesis. Woodruff 3 and Woodruff and Richardson 4 feel that vulvar Paget's disease is a carcinoma of epithelial origin, whereas Weiner 5 and more recently, Dockerty and Pratt, 6 support the thesis that Paget's cells migrate