Is radiation therapy a treatment option for refractory Paget's disease of the vulva extending onto skin of buttocks and anal margin?  

I have treated localized peri-anal Paget's Disease with good outcomes, and there is some data to support this. I have not treated a patient with such widespread vulvar Paget's and I suspect that the morbidity would be significant given the doses required, and the volume to be treated in the case you...

I would use topical imiquimod cream, an effective and underused modality. It can be used either as curative, or as an adjuvant to radiation. It can either eliminate the need for radiation or greatly decrease the size of the field you will need. It can cause a skin reaction that looks similar to...