Long-term ALA-PDT for Giant Extramammary Paget's Disease in a Centenarian: A 5-Year Case Study with 58 Sessions

Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that poses significant therapeutic challenges due to its refractory nature and high recurrence rate. Although surgery remains the standard treatment, non-surgical alternatives are crucial for elderly patients with extensive lesions or multiple comorbidities. 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) selectively targets and destroys tumor cells through the application of a photosensitizer and corresponding light source. Here, we report the case of a centenarian male with extensive primary perineogenital EMPD. He was unsuitable for surgery due to advanced age, poor general health, large lesion size, and sensitive anatomical location. The patient received ALA-PDT as long-term palliative treatment, with a total of 58 sessions over five years. This regimen achieved durable local control, was well-tolerated, and preserved the patient's quality of life. This is the oldest reported EMPD patient treated with ALA-PDT and the case with the highest cumulative number of ALA-PDT sessions. This suggests that ALA-PDT is a safe and effective long-term palliative treatment option for high-risk elderly patients.