Extramammary Paget disease (EMPD) is a rare neoplasm usually presenting in the anogenital area, most commonly in the vulva. Adnexal involvement in primary EMPD is a very common feature and serves as a pathway for carcinoma to spread into deeper tissue. The depth of carcinomatous spread along the appendages and the patterns of adnexal involvement were studied in 178 lesions from 146 patients with primary EMPD. Hair follicles and eccrine ducts were the adnexa most commonly affected by carcinoma cells. The maximal depth of involvement was 3.6 mm in this series. When planning topical therapy or developing novel local treatment modalities for EMPD, this potential for significant deep spread along adnexa should be taken into account.

*Department of Pathology Clinical Research and Practical Center for Specialized Oncological Care Saint Petersburg Russia; †Department of Pathology Medical Faculty Saint Petersburg State University Russia; ‡Department of Pathology Petrov's Research Institute of Oncology Saint Petersburg Russia; §PathWest Laboratory Medicine WA King Edward Memorial Hospital Perth Western Australia Australia; ¶PathWest Laboratory Medicine WA QEII Medical Centre Nedlands WA Australia; ‖University of Western Australia School of Pathology and Laboratory Medicine Nedlands WA Australia; **Dermatopathologische Gemeinschaftspraxis Friedrichshafen Germany; ††Sikl's Department of Pathology Medical Faculty in Pilsen Charles University Prague Pilsen Czech Republic; ‡‡Bioptical Laboratory Pilsen Czech Republic; §§Miraca Life Science Irving TX; ¶¶Department of Pathology Division of Dermatopathology Medical College of Wisconsin Milwaukee WI; ‖‖Department of Obstetrics and Gynecology Charles University Medical Faculty Hospital Pilsen Czech Republic; ***Department of Pathology Regional Hospital Most Czech Republic; and †††Dermatopathology Unit Department of Dermatology Zurich University Hospital Zurich Switzerland

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