Successful Treatment of Primary Extramammary Paget Disease with a Combined Ablative Carbon Dioxide Laser and Topical Imiquimod

Extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma primarily affecting apocrine-rich areas, most commonly the vulva in elderly women. While surgical excision is the gold standard, its limitations in extensive disease necessitate alternative therapies. We report a case of a 75-year-old woman with a 2-year history of progressive vulvar erosion diagnosed histologically and immunohistochemically as primary EMPD. Owing to the lesion’s extent and the patient’s preference to avoid surgery, she was treated with a combination of ablative carbon dioxide (CO 2 ) laser therapy and topical 5% imiquimod. Four biweekly sessions of CO 2 laser therapy yielded significant resolution in the upper vulva, while residual disease in the lower vulva responded completely to a three-month course of imiquimod cream applied thrice weekly. Follow-up biopsy at six months confirmed histological remission, and no recurrence was observed at 12 months. This case highlights a successful, non-invasive treatment approach combining laser ablation with immunomodulatory therapy, offering a promising alternative to surgery in extensive EMPD with favorable outcomes and cosmetic acceptability.