This rare skin cancer is often mistaken for an itchy rash
Here's what to know about EMPD, including how to recognize the easy-to-miss signs.
Author of the article:Washington Post
Washington Post
Erica Sweeney
Published Sep 08, 2026 • Last updated 1 day ago • 5 minute read
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For 20 years, Laurie Hill experienced a burning, itchy rash on her genitals. Her gynecologist initially diagnosed her with dermatitis and recommended a cortisone cream.
But Hill, 67, of Galveston, Texas, said this just amplified her symptoms. Over the years, she tried to ignore the itching but it got worse. And then, she noticed discoloration and sores on her vulva.
Two years ago, she went to see her doctor, who did a biopsy on the lesions and diagnosed her with a type of skin cancer called extramammary Paget’s disease, or EMPD.
Hill’s experience highlights the complexity of diagnosing and treating EMPD. It’s rare – affecting an estimated few thousand people in the United States – but when it does show up, it closely resembles other skin conditions, making it difficult to diagnose. It causes a red or dark-colored, scaly rash on the vulva, scrotum, penis and perianal area that over time, can spread if it’s not treated.
Additionally, people are sometimes embarrassed to discuss these symptoms with their doctor, said Anthony Rossi, a dermatologist and Mohs surgeon at Memorial Sloan Kettering Cancer Center in New York City. This can further delay diagnosis and treatment.
Some data show EMPD diagnoses have increased about 1.2 percent each year between 2000 and 2020 for both men and women, though it primarily affects women between the ages of 50 and 80.
Part of the explanation for the uptick in EMPD may be that there’s more information about the cancer available online, and more doctors are recognizing and properly diagnosing EMPD, said Jamie Bakkum-Gamez, a gynecologic oncologist at the Mayo Clinic in Rochester, Minnesota.
Here’s what to know about EMPD, including how to recognize the easy-to-miss signs.
EMPD is a slow-growing skin cancer, Rossi said. It typically appears in areas with apocrine glands – a type of sweat gland – such as the genitals, Bakkum-Gamez said.
Most EMPD cases are “primary,” meaning they start in these locations. EMPD also can be “secondary” and develop as a result of a different underlying cancer, such as colorectal or bladder cancer. EMPD itself can also metastasize to other parts of the body, Rossi said, such as the lymph nodes or bones, and the cancer can be fatal.
According to research, the five-year survival rate for noninvasive (contained to the outer layer of the skin) and microinvasive (just barely entering the second layer of skin) EMPD is high, at 90 to 100 percent. Other research has found a five-year survival rate for invasive EMPD (where the cancer has grown into deeper layers of skin) of 72 percent compared to the general population, and a five-year overall survival rate for EMPD of 74 percent.
Intense itching is the most common symptom, said Bakkum-Gamez. EMPD can also burn and be painful, said Viraj Master, a urologist and co-founder of the Crotts Global Initiative for Extramammary Paget’s Disease at Emory University in Atlanta. Depending on the cancer’s location, it can affect someone’s sexual functioning or ability to urinate or have a bowel movement, said Master.
EMPD usually causes a red, scaly rash: “The frustrating thing about EMPD is that it can look so nonspecific,” said Melissa Mauskar, a dermatologist and director of the Vulvar Health Program at the University of Texas Southwestern Medical Center in Dallas.
Sometimes, the rash has an overlying white cast, she said. “In dermatology, it is referred to as a ‘strawberry-and-cream’-like appearance. But patients can also have a very subtle light pink or red rash on their vulva or penis.”
Because of this, EMPD is often misdiagnosed as jock itch, fungus, eczema or another skin condition, Rossi said. But it won’t respond to antifungal medications, hydrocortisone or other treatments for these ailments.
If you have genital itching or burning for more than two weeks or notice a rash in the area, make an appointment with your health care provider, Mauskar said.
Sometimes, doctors notice the lesions during a routine gynecologic or urology exam and recommend a biopsy, but many won’t recognize it, Rossi said. There are no regular screening guidelines for EMPD.
If your doctor treats you for eczema or another skin issue and it doesn’t improve after about a month, ask about EMPD and getting a biopsy, Mauskar said. A biopsy, where a small piece of skin is removed and examined under a microscope, is the only way to diagnose EMPD, Master said.
Getting diagnosed can take time. Research suggests people have symptoms for two years, on average, before receiving an EMPD diagnosis. For some, like Hill, it can take much longer.
There’s no one-size-fits-all approach, Rossi said, but there are a few treatment options, depending on the cancer’s size and location.
EMPD can be surgically removed, with either Mohs surgery, where the tumor and thin layers of tissue around it are removed a little at a time until there are no signs of cancer cells at the edges; or wide local excision, which removes a larger area of skin right away.
Bakkum-Gamez was a co-author of a 2023 study that found women who received Mohs surgery experienced a 93.3 percent three-year recurrence-free survival rate compared to 66 percent for patients who had wide local excision.
If the cancer is too close to the anus, urethra or clitoris, surgery could impair one’s ability to go to the bathroom, or their sexual function, and might not be recommended, Rossi said.
Surgery is also difficult if the lesions spread over large areas of skin, such as across the thighs, Bakkum-Gamez said. Surgeons would need to remove large swaths of skin, and it can be difficult to remove all of the cancerous cells, Rossi added.
Another treatment is the topical immunotherapy cream imiquimod, which may be used alone or with surgery, Rossi said. In a 2023 systematic review, 67 percent of patients saw their symptoms improve with the treatment.
But the drug comes with many potential side effects, including pain, burning and joint and body aches, Bakkum-Gamez said.
Other options include the topical chemotherapy medication 5-fluorouracil, and radiation is recommended for invasive EMPD, Rossi said.
After her diagnosis, Hill began seeing a gynecologic oncologist and started using imiquimod, which she said causes headaches, exhaustion and more itching and burning. When she uses it, she said, “I sit on ice packs for the bulk of the day.”
Even with treatment, Hill said she’s unable to exercise and carries a pillow with her in case she has to sit on a hard surface. Soon, she’ll undergo tests to see if the cancer has spread to her bladder or urethra.
More research is needed to better understand EMPD, Mauskar said. But early detection remains crucial. “Listening to your body and partnering with your health care team can help guide individual treatment,” she said. “Most patients do quite well if this is caught early.”
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