Intralesional ALA-PDT for residual extramammary Paget's disease: a case report
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By
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Jianhua Huang
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Dongya Wang
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Yiwu Yu
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Szeman Cheung
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Li Xiao
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Fei Miao
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Wenjing Zha
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Yitao Qian
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Ke Li
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Lei Shi
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June 30, 2026
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Clinical Scorecard: Intralesional Photodynamic Therapy with ALA for Persistent Extramammary Paget's Disease: A Case Study
At a Glance
| Category | Detail |
|---|
| Condition | Extramammary Paget's Disease (EMPD) |
| Key Mechanisms | Intralesional photodynamic therapy (ALA-PDT) enhances photosensitizer delivery to deep dermal lesions. |
| Target Population | Patients with residual EMPD after surgical excision with positive margins. |
| Care Setting | Dermatology department for local adjuvant therapy. |
Key Highlights
- Intralesional ALA-PDT achieved complete clinical regression after six sessions.
- Treatment was well-tolerated with mild pain and transient erythema.
- No recurrence observed during the 6-month follow-up period.
Guideline-Based Recommendations
Diagnosis
- Histopathological examination confirms EMPD diagnosis with tumor infiltration.
Management
- Intralesional ALA-PDT is recommended for residual EMPD when re-excision is not feasible.
Monitoring & Follow-up
- Pre-treatment high-frequency ultrasound and dermoscopy are useful for assessing lesion characteristics.
Risks
- Potential for positive surgical margins and local recurrence if not adequately treated.
Patient & Prescribing Data
Elderly male with scrotal EMPD and positive surgical margins.
10% ALA solution injected intralesionally followed by light irradiation.
Clinical Best Practices
- Use aseptic techniques for intralesional ALA preparation and injection.
- Ensure adequate incubation time for photosensitizer accumulation before irradiation.
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