Patient-Reported Symptom-to-Diagnosis Interval and Documented Prior Eczema/Dermatitis Diagnosis in Relation to Dermal Invasion in Extramammary Paget Disease: A Retrospective Cohort Study
Minhee Hwang, Seokgyun Lim, Hoon-Soo Kim, Changryul Claud YiBackground:
Extramammary Paget disease (EMPD) frequently mimics chronic eczema/dermatitis, contributing to delayed diagnosis. Although dermal invasion is prognostically important, it remains unclear whether diagnostic-timeline measures are associated with invasion at diagnosis.
Objectives:
To estimate the associations of the patient-reported symptom-to-diagnosis interval and a documented prior eczema/dermatitis diagnosis with the presence of dermal invasion at EMPD diagnosis.
Methods:
We reviewed patients with histologically confirmed EMPD at a tertiary center (May 2006-August 2025). Symptom-to-diagnosis interval was patient-reported; prior eczema/dermatitis was confirmed by external records or referral letters. Invasion used maximum depth in definitive surgical specimens. Primary logistic regression adjusted for age and sex; Firth sensitivity analysis also included involved-subunit count.
Results:
Of 92 patients, 84 had evaluable depth; 64 (76.2%) had dermal invasion. Median interval was 24 months (interquartile range 7-36) without and 24 months (12-48) with invasion (
Conclusions:
Neither measure showed a detectable association, but the small noninvasive group and wide confidence intervals leave meaningful effects unresolved. Referral-enriched case mix limits generalizability; a short interval does not exclude invasion.