Table 1.

A summary of different management strategies for EMPD.

Management	Modality	Summary
Non-surgical management	Topical treatment: imiquimod	•Works [17,18] by innate immune pathway stimulation and inducing inflammatory cytokines such as IL-6, IFN-alpha, and TNF-alpha producing an antitumor effect •Advantage: small degree of clinical improvement observed •Disadvantage: no complete response
	Photodynamic therapy: photoreactive drugs, such as aminolaevulinic acid	•Exposure to appropriate wavelength of light and creating toxic-free radicals which destroy tumor cells •Advantage: non-invasive •Disadvantages: palliative treatment, pain, and photosensitivity
	Radiation therapy	•Radiation doses ranging from 10 Gy to 64 Gy; study [18] showed 97% patients showing CR with 50% achieving improvement •Advantage: primary or adjuvant therapy •Disadvantages: mucosal and dermatological toxicities, leukopenia, and variable degree of colitis, cystitis, and urethritis
	Laser ablation: Neodym:YAG, CO2, and holmium lasers	•Advantages: shorter operative time and less bleeding, •Disadvantage: longer healing period
Surgical management	Surgical excision, punch biopsy, and Mohs micrographic surgery	•Advantages: fewer recurrences with wide local excision •Disadvantages: tumor border irregularities with unclear margins missing satellite lesions.
Systemic therapy	Combination drug therapies: FP, FECOM, and PET therapy	•Advantage: ideal for metastatic cases •Disadvantages: insufficient data due to sample size

CR, complete remission; EMPD, extramammary Paget's disease; FECOM: 5-FU, epirubicin, carboplatin, vincristine, and mitomycin C; FP, 5-fluorouracil and cisplatin; PET, cisplatin, epirubicin, and paclitaxel; IL-6, interleukin 6; IFN-alpha, interferon alpha; TNF-alpha, tumor necrosis factor-alpha.