Perianal eczematous skin cancer

Mr. Feng, 49 years old, was admitted to the hospital due to "anal itching and discharge for more than 4 years".

Medical history

Current medical history: The patient has felt anal itching and fluid secretion in recent years. Usually, he has 7-8 bowel movements a day. Recently, his stools are not hard and dry. When the stools are hard and dry, he has pain during defecation and blood in the stool. He has also lost a lot of weight, losing about 10kg.

Physical examination

No obvious abnormalities were found in the inguinal lymph nodes, heart and lungs. Erosions and granulation-like growths were seen on the anal skin, which were brittle and bleed on contact. Digital examination of the anorectal canal revealed that the wall was hard and slightly narrow, with a small amount of fresh blood attached to the fingertip.

Testing

Electronic colonoscopy showed: erosive proctitis and melanosis of the large intestine (2011-9-26). The anoscope could not be inserted smoothly. The pediatric anoscope showed erosion and bleeding of the rectal mucosa, slight bulge of the dentate mucosa, and 2 biopsies of the perianal neoplasms.

Diagnosis and treatment

This is a rare special case in clinical practice. The patient had anal itching and fluid secretion for more than 4 years. The patient had a long medical history and symptoms similar to eczema. Weight loss suggested the presence of malignant lesions. Based on the results of the specialist examination and the medical history, anal Paget's disease was suspected. The pathological diagnosis was anal Paget's disease, a type of skin cancer, also known as eczematoid cancer.

The disease has a slow onset and a long history, and often has a long history of misdiagnosis with treatment for diseases such as eczema, hemorrhoids, and condyloma acuminatum. Perianal refractory itching is often the initial symptom, which may be painful or may not be conscious, and only presents as an eczematous appearance. Therefore, if perianal eczema spots are accompanied by refractory itching and cannot be relieved by topical corticosteroids, this disease should be highly suspected.

The patient refused surgery after being admitted to the general surgery department and strongly requested photodynamic therapy (PDT). After communicating with the patient and his family, it was decided to transfer him to the oncology department for PDT treatment. Three days after intrarectal PDT treatment, local severe pain was obvious, and he was discharged after symptomatic treatment with analgesics and antibiotics.