Which is NOT a diagnostic issue when evaluating vulvar Paget disease?

• A. Determining site of origin
• B. Assessing margin status
• C. Determining stage of metastasis
• D. Assessing for stromal invasion

Answer: (C)

Evaluating vulvar Paget disease centers on local features that guide treatment and prognosis. It’s important to determine the site of origin because Paget cells can arise primarily in the vulvar epidermis or secondarily from an underlying malignancy; knowing the origin shapes the subsequent workup and management. Assessing margin status is crucial for surgical planning—clear margins reduce the risk of recurrence, so the pathology report checks how close tumor cells come to the excision edge. Assessing for stromal invasion matters because the presence and depth of invasion change prognosis and may influence the extent of surgery or the need for additional therapy. Determining the stage of metastasis, however, isn’t part of the core diagnostic assessment of the vulvar lesion itself; systemic staging would be pursued only if there is suspicion of spread or invasion, using imaging and clinical evaluation rather than as a routine diagnostic feature of the vulvar Paget disease.