In 1874, James Paget first described 15 cases of a typical crusty lesion caused by breast cancer, known as eczema-like carcinoma of the breast, and this disease became known as Paget’s disease [1], also known as eczema-like carcinoma. The disease occurs mostly in the female breast, but can also occur in the male breast and other areas rich in sweat-secreting functions, such as the male or female external genitalia, perianal area, and axillae, the latter being called extramammary Paget’s disease (EMPD), which is less common clinically [2]. PPD, a subtype of EMPD, is much rarer clinically [3] and is characterized by well-defined eczema-like patches with intractable pruritus. Once pathologically confirmed, complete surgical excision of perianal Paget disease should be preferred. A patient with PPD was admitted to our hospital in July 2009 and was treated with an extended local excision combined with inguinal flap transfer plus V-Y flap nudge. 1. Clinical data The patient was female, 80 years old. Anal pruritus with no obvious cause started 4 years before admission and worsened in the last 6 months. On examination after admission, the perianal skin was moist and flushed, with a clear boundary between it and the surrounding normal skin, slightly above the skin, with yellow-brown crust and gray-white moss-like material, with surface erosion, and a perianal lesion area of 8*6 cm. No inguinal lymph node metastasis was detected on palpation. Preoperative biopsy pathology: extramammary Paget’s disease. Colonoscopy of the rectal mucosa and dentate line did not reveal Paget cells. No potential invasive carcinoma was found preoperatively, and there was no evidence of distant metastasis. The patient was placed in a lithotomy position with a pillow under the lumbar area to elevate the hips. General anesthesia was used during surgery. The extent of resection was marked with melanoma (1.5 cm outside the lesion) and a free flap was designed. The local extended resection area included the rectal mucosa, subcutaneous fat in the suspected area and part of the external sphincter. A free right inguinal flap, approximately 20 cm in length, was wrapped around from top to bottom, encircling the anal canal and intra-anal defect, and sutured to the rectal mucosa and external sphincter. A V-shaped flap was made on the left side, pushed toward the anus, and sutured to the outer edge of the inguinal flap at the anal canal, and the flap donor area was sutured in one stage. To avoid accumulation of blood and fluid below the incision, the skin lesion on the right side of the anal margin was sutured with an anterior drainage tube (Figure 4). The postoperative incision was wrapped with burn gauze with pressure. Postoperative pathological examination: the skin tissue was sent for examination, and a thickened epidermal acanthocyte layer was seen, in which round or polygonal paget cells with lightly stained cytoplasm were seen, with large, lightly stained, heterogeneous nuclei; no infiltration was seen in the intact epidermal base, and inflammatory cell infiltration was seen in the dermis, and tumor cells were seen 1 cm from the cut edge on one side and 1.2 cm from the cut edge on the other side. After the operation, the patient was asked to rest on the right and left side. Postoperatively, 0.5% metronidazole 100ml was used 2 times/day + Pioneer 6 2g 2 times/day for three days. After 7 days of intravenous nutrition, oral enteral was given.