Extramammary Paget's Disease of the Suprapubic Region in a Male: A Novel Diagnostic Imaging Approach and Literature Review.

Extramammary Paget's disease (EMPD) is a rare cutaneous adenocarcinoma typically arising on apocrine gland-rich skin. This suprapubic location is exceptionally rare. Its nonspecific erythematous plaques often mimic benign inflammatory or infectious dermatoses, delaying diagnosis. We report an 80-year-old male who presented with a chronic suprapubic plaque. Videodermoscopy and line-field confocal optical coherence tomography (LC-OCT) highlighted irregular vascular patterns and pagetoid cells, raising suspicion for EMPD and guiding a biopsy. Histopathology confirmed carcinoma in situ, and immunostains (CK7 positive, CK20 negative) supported a primary cutaneous origin. Comprehensive screening ruled out associated malignancies; however, guidelines note that colon, rectal, prostate, and bladder cancers are the most frequent synchronous tumors and suggest considering tailored internal malignancy screening. Wide local excision achieved clear margins; after one year, there is no recurrence. The literature indicates that recurrence remains frequent after surgery and may not correlate with margin width, necessitating careful long-term surveillance. For patients unfit for surgery, alternative therapies include radiotherapy, topical imiquimod, and photodynamic therapy, though photodynamic therapy appears palliative rather than curative. Non-invasive imaging modalities, such as LC-OCT, provide high-resolution "virtual histology," enhancing early diagnosis and reducing the need for repeated biopsies. Early recognition, appropriate staging, and multidisciplinary management are crucial for improving outcomes.