Applying topical 5% imiquimod or 5-fluorouracil prior to Mohs surgery or ablation for extramammary Paget's disease helps identify all of the active foci and can reduce the risk of recurrence, says Dr. Theodore Rosen, a professor of dermatology at Baylor College of Medicine. Imiquimod as primary therapy has a 22% failure rate, and wide surgical excision alone has a recurrence rate of up to 54%, studies show. Some research suggests that cytokeratin staining can help determine whether patients also have an internal malignancy.

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