**5. Conclusions**

CV involvement from EMPD is a rare condition but should not be underestimated in women with a long-standing history of vulvar Paget's disease. It can be promptly detected by cytology, which is a valuable and reliable tool for early diagnosis and should be routinely performed during the required lifelong follow-up.

**Author Contributions:** Conceptualization, A.D.I., M.E.G., E.P.P. and N.S.; Methodology, A.D.I., M.E.G., C.S. and M.G.; Software, A.D.I., M.E.G. and G.P.; Validation, A.D.I. and V.B.; Formal Analysis, G.P. and V.B.; Investigation, A.D.I., M.E.G., E.P.P., N.S. and G.R.; Resources, A.D.I., E.P.P., N.S., G.T. and A.M.; Data Curation, A.D.I., M.E.G. and G.P.; Writing—Original Draft Preparation, A.D.I. and M.G.; Writing—Review and Editing, A.D.I., M.E.G., G.R., G.T. and F.B.; Visualization, A.D.I., C.S. and M.G.; Supervision, F.B. and A.M.; Project Administration, A.D.I. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the European Institute of Oncology, Milan, Italy (IEO protocol number: UID 2408; date of approval: 22 June 2020).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data presented in this study are available upon request from the corresponding author. The data are not publicly available due to the patients' privacy restrictions. The data are safely stored in a private database of the European Institute of Oncology, Milan, Italy.

**Acknowledgments:** This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.

**Conflicts of Interest:** The authors declare no conflict of interest. None of the authors received financial support or funding for this work.
