case_images: PMC11228168_01
case_images: (A, B) Modified clock mapping technique. (A) A graphic representation of the sites where the biopsy should ideally be performed. The clinically evident edges of the lesion constitute perimeter A. Perimeter B is drawn 1.5 cm away from A; (B)
  In vivo application of clock mapping.
case_images: pore-30-1611803-g001.jpg
case_images: PMC11228168_01_pore-30-1611803-g001.jpg
case_images: F1
case_images: Tomography were negative. Therefore, we decided to apply the "modified clock mapping" surgical technique in order to better understand its spread and to establish the tissue excision margins (Figure 1B).
case_images: Final result of radical total vulvectomy.
case_images: pore-30-1611803-g002.jpg
case_images: PMC11228168_01_pore-30-1611803-g002.jpg
case_images: F2
case_images: Finally, after detailed counseling and obtaining written informed consent, the surgeon (L.D.C.) performed a total radical vulvectomy with an ipsilateral inguinofemoral sentinel lymph node biopsy (Figure 2).
case_images: (A, B) Intraepithelial Paget's disease. (A) Hematoxylin-eosin staining shows atypical, polygonal, large glandular cells with abundant vacuolated cytoplasm, hyperchromic nuclei, and evident nucleoli resembling Paget's cells; (B) GATA3 Immunohistochemical Staining is positive.
case_images: pore-30-1611803-g003.jpg
case_images: PMC11228168_01_pore-30-1611803-g003.jpg
case_images: F3
case_images: The histological examination confirmed the dual vulvar diagnosis of invasive and non-invasive EMPDV with 1 cm of healthy surgical margin (Figures 3A, B), while the sentinel lymph node was negative.