• Affects apocrine-gland skin - genital, perianal skin, axillary
• High grade; 60% survival at 10 years
• Primary - arises as CIS
• Secondary - direct spread from nearby underlying malignancy (eg prostate or rectal or cervical cancer), (about 20-30%)
• Whereas Paget's of the breast is 100% associated with underlying ductal malignancy

Well-demarcated erythematous plaque

• Wide local excision (2cm margin?) high rate of recurrence. May have skip lesions/multifocal lesions, difficult to get negative margins.
• Mohs microsurgery
• Non-surgical - imiquimod 5% cream, laser therapy