Cryosurgery and photodynamic therapy for the treatment of Paget's disease of the vulva: two cases

Surgery is the standard treatment for vulvar Paget's disease, despite its mutilating consequences and the high associated recurrence rate. Alternative treatments such as CO₂ laser, application of imiquimod and topical photodynamic therapy (PDT) have recently been proposed. We report on two patients with vulvar Paget's disease treated with combined cryosurgery and PDT. Case 1: a 40-year-old pregnant woman presented large vulvar lesions suggestive of Paget's disease. After imiquimod treatment failed, three sessions of cryosurgery were performed on all lesions at 5-month intervals, followed by PDT sessions for the residual erythema. Because of recurrent focal lesions, further sessions of localized cryosurgery were performed for 18 months. Case 2: a 61-year-old patient with extensive vulvar Paget's disease relapsed after imiquimod treatment and was treated by cryosurgery and multiple PDT sessions. She was in complete remission 12 months after this treatment. Combined cryosurgery and PDT may offer a therapeutic alternative to conventional surgery for the treatment of large or recurrent multifocal vulvar Paget's disease, or in elderly people. Indeed, although palliative, these two non-invasive techniques can be used to treat many lesions in a single session. Recurrences can be treated again using either technique, or both, without any aesthetic or functional consequences.