Extramammary Paget’s Disease of the Suprapubic Region in a Male Patient: A New Diagnostic Approach – Case Report

Background: Extramammary Paget’s disease (EMPD) is a rare intraepithelial adenocar-cinoma that typically involves apocrine gland–bearing areas such as the vulva, scrotum, and perianal region. Suprapubic localization is exceptionally uncommon, particularly in male patients, often leading to delayed diagnosis due to its nonspecific presentation. Case Presentation: We report the case of an 80-year-old male presenting with a persistent erythematous, pruritic plaque in the suprapubic region that was unresponsive to topical corticosteroids and antifungal therapy. Clinical examination revealed a well-demarcated erythematous lesion with superficial erosion and scaling. Videodermoscopy and Line-Field Confocal Optical Coherence Tomography (LC-OCT) revealed features sug-gestive of intraepidermal neoplasia. Histopathological examination demonstrated large, atypical Paget cells within the epidermis, showing abundant pale cytoplasm and pleo-morphic nuclei arranged in a pagetoid distribution. Immunohistochemistry showed strong positivity for Cytokeratin 7 (CK7) and negativity for CK20 and CDX2, confirming the diagnosis of primary EMPD. The patient underwent wide local excision with clear margins, followed by an uneventful recovery. No recurrence was observed during one-year follow-up under dermatologic surveillance. Conclusion: This case highlights the diagnostic challenges of EMPD in atypical locations such as the suprapubic region. Non-specific clinical and dermoscopic features frequently result in misdiagnosis and delayed treatment. Integration of non-invasive imaging techniques like LC-OCT can assist in early detection and biopsy guidance. Histopatho-logical and immunohistochemical evaluation remain essential for accurate diagnosis and differentiation from other malignancies. Early recognition and complete surgical excision are crucial for optimal outcomes and recurrence prevention.