Our aim was to determine the usefulness of fluorescence examination and
photodynamic therapy (
PDT) for the management of perianal
extramammary Paget's disease. A 75-year-old woman underwent two courses of
PDT. The first treatment was carried out with topically applied 5-aminolevulinic
acid (ALA) to the affected area (2.5 x 2.5
cm(2)) 3 h before light treatment. We used ALA/
protoporphyrin IX (
PpIX)-mediated fluorescence to visualize the lesion and its margins. The lesion was treated with a 630 nm
laser at 120 J/cm(2). Forty days later, the residual lesion was given a second treatment at the same light dose after topical application of ALA and
intravenous injection of HiPorfin. ALA/
PpIX-mediated fluorescence served as a useful tool to visualize the lesion's location. Complete cure was achieved after the second course of
PDT. During 7 months of follow up, no recurrence,
scarring or functional loss was noticed. We concluded that ALA-assisted fluorescence examination can be a useful tool to determine the lesion and its margins. ALA-
PDT is effective for superficial lesions, but, for thicker and deeper lesions, the systemic administration of
photosensitizer is needed.