It is often difficult to accurately judge the clinical tumor margins for extramammary Paget disease. Mohs micrographic surgery was used to extirpate a tumor which clinically measured 159.5 cm2. Following Mohs micrographic surgery, it was found that the actual dimensions of the tumor had been underestimated by 97 per cent. Since the Mohs micrographic surgeon microscopically examines the entire subcutaneous margin of the resected tumor, this technique provides an accurate method of determining the depth of tumor penetration. Mohs micrographic surgery allows for maximal conservation of normal tissue and yields higher cure rates than other conventional methods of treatment. When approaching tumors of the genitalia which may display poorly defined clinical margins, Mohs micrographic surgery should be considered the technique of choice.
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