Extramammary Paget Disease: Failure to Respond to Topical Imiquimod 5%

Two elderly Asian men with primary extramammary Paget disease (EMPD) involving the scrotum did not respond to a 4- to 6-month trial of topical imiquimod 5%, despite previous reports of successful treatment. The first patient, a 75-year-old Chinese man, experienced a vigorous inflammatory reaction but showed no improvement and was subsequently treated successfully with radiation therapy. The second patient, a 70-year-old Japanese man, also failed to respond to imiquimod 5% and was scheduled for radiation therapy. These cases highlight that imiquimod 5% may not be effective for all patients with scrotal EMPD.