Here is one of the largest series to date examining outcomes following radiation for extramammary (mostly perineal) Paget’s disease, notorious for insidious margins and high risk of local recurrence. It includes 106 patients treated at a single center in China between 2012–2021 either adjuvantly (to 50 Gy for negative margins and 60 Gy for close or positive margins) following either Mohs (n=87) or wide local excision (n=6) or definitively (to 66–70 Gy) if inoperable (n=13). With a median follow-up surpassing 5 years, local control was excellent, exceeding historical controls: 95% at 5 years and 88% at 10 years. Rate of nodal metastases was 9% and of distant metastases 17% at 10 years. Of note, presence of dermal invasion increased local recurrence risk. Ultimately the authors suggest pursuing Mohs excision standardly followed by adjuvant radiation when feasible and definitive radiation when inoperable. | Min Adv Radiat Oncol 2026
