In females, the perineum begins at the front of. I have them since 1-2 years, everytime after using ointment/cream bumps goes out but came back after some days. So my perineal raphe has been hurting for a about a week now. On vulvar skin, the most common symptoms are soreness, burning, and rawness. local irritation as a result of wiping, and urinary tract infections. I am a young (20 yrs) female and I have a question about the perineal raphe. Due to the cessation of random erections, the erectile tissue will atrophy if not regularly put to use, causing the entire penis to shrink over time. perineal翻译：会阴部的。了解更多。The penile raphe is a thin strip of tissue that runs along the underside of the penis, from the tip of the glans down to the perineum (the area between the scrotum and anus). Image acquired using minimal zoom on a surgical, digital camera. Dansk: 21 årig kvindes anus med fremtrædende Perineal raphe (en sammensmeltning ved mellemkødet, oftest set hos mænd). Along this tract, which extended across the median raphe of the penis and scrotum, were several cj^stic areas, the largest measuring 2 cm. Perineal grooves in two newborn babies were. Lacerations can occur spontaneously or iatrogenically, as with an episiotomy, on the perineum, cervix, vagina, and vulva. im 38 years old and have a scar on my penis (perineal raphe). The perineum can be divided into two triangular portions by the line between the ischial tuberosities. The term "IPPP" was introduced in the medical literature within the past 10 years. The raphe, that mysterious “ stitch” running along the bottom of the scrotum, is a remnant of our shared human development in the womb. Median raphe cysts usually appear before 30 years of age. Although the incidence and pathogenesis of perineal groove is unknown, there is a clear female predominance. Itching and pain. La rainure périnéale congénitale (perineal groove), est une malformation anopérinéale rare, survenant presque toujours chez des filles et correspondant à un rainure érythémateuse suintante, s’étendant de la fourchette vulvaire postérieure au bord antérieur de l’anus [1], [2], [3]. Case report: cobblestone A 23 year old married man presented to the STD clinic with a complaint of gradual splitting of median raphe. The area is itchy and starts just under my scrotum and ends at the anus. With the many pains of pregnancy finally over, you are ready to focus on your baby and regain some sort of composure. Perineal pain or perineum pain is often caused by infection of perineal skin, subcutaneous tissue or deeper tissue like anus, vulva and vagina. Should go away on its own. Doctoral Degree. Perineal groove is a rare anoperineal congenital malformation disease that usually affects newborn females. The perineal raphe is visible. Although the rate of perineal wound infections has been reduced with the aid of flaps,[6] several studies have reported that ELAPE may increase postoperative perineal morbidity such as chronic perineal pain, perineal wound infection, urinary retention, perineal herniation, and sexual dysfunction. While hemorrhoids may trigger perineum pain, they don’t cause perineum swelling. Raphe means the line of union of the two halves of various symmetrical body parts, and the term median raphe refers to the perineal raphe, which is also known as the median raphe of the perineum. Median raphe cyst is an uncommon developmental anomaly that can develop anywhere along the midline of the external genitals. We present a case and review the literature in respect to a 35-year-old man with a non-visible, painless midline swelling in the anterior perineum initially thought to. lately i started feeling like that part of mine is now a bit more thicker. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. Hemorrhoid wipes and creams can help with pain, itching or burning in your perineum, too. bulbospongiosus, in male. Nerve irritation. NSFW. Microscopically, there is epidermal acanthosis, marked edema, and mild inflammatory. 4 years ago. The itching/burning/prickly feeling is unbearable and worse at night, and when I wipe after a bowel movement. Lower back pain; History of herpes zoster or trauma. REPORT OF A CASE An American of Bohemian ancestry, aged 23, was first seen on Feb. Increased pain, swelling, redness, or warmth in the perineal area. Keywords: Median raphe cyst, Penis, Scrotum, Perineum, Excision. Apply cool compresses to the perineal area to soothe burning sensations. The raphe joins the internal. Perianal region is an extremely rare location for these lesions. I use a small amount of Estrace cream as well as a steroid ointment once weekly as maintainance for Lichen Sclerosis. Early perineal raphe and the urethral wall in a 10-week male fetus without a definite penile raphe. If you have concerns, seek examination by Physician or Dentist. anal warts 3. Temporary erectile dysfunction might be experienced by some patients . Pain after Radiation for Prostate Cancer. The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). The perineal raphe is generally considered to mark the line of fusion between the so-called urethral folds (Glenister 1954; Hamilton and Mossman 1972), or of a combination of urethral folds and scrotal swellings (Szenes 1925; Wartenberg 1993), or between urethral folds for the penile raphe and between scrotal swellings for the scrotal. MRC is thought to be caused by congenital alterations in the embryologic development of the male. Bacterial infections can lead to an inflammation of the prostate and it could be a cause of pain after ejaculation that you need to watch out for. compresses the vestibular bulb and constricts the vaginal orifice. Get App. 5%) and haematospermia (37. i'm getting intermittent scabbing/bumps on what i believe is called the perineal raphe. Therefore gents, you have a bit of a labia on your scrotum. The cysts can occur at parameatus, glans penis, penile shaft, scrotum, or perineum. I've had it about 3 years now. Learn how we can help. I may take hobby’s suggestion and do the Smores stretches dry, but after a really good warmup, from now on. I can hold it well with two fingers when pressed hard . When the area is numb, your OB/GYN may then use a. Easy. 2. What Causes Perineum Pain? In all sexes In males In females Takeaway The perineum lies near several nerves, muscles,. Hi doctor, i have bumps/blisters/redness with heavy itching and irritation on my outer back side of penis (mostly on perineal raphe). Referred pain: A variety of. Methods: We enrolled men with gonococcal infection of the penile raphe and men with urethral. Firstly, my perineal raphe looks red and raised. In winters i had them rarely but now summer is starting & again bumps are appearing on my perineal raphe. It may present with itch, pain, bleeding or a lump that doesn’t respond to the standard treatments. Oct 08, 2019 · Perineal pain can affect people of both sexes. Perineal groove is a rare congenital midline malformation of the perineal raphe. The perineum pain between the genitals and anus can be commonly caused by anal fissures. Radical orchidectomy: Also known as a radical inguinal orchiectomy, this is a more. Contract. Scrotal Raphe. Injuries Impacts to the groin area during physical activity or from falling on your rear can bruise, tear, or rip your perineum, causing a lump there. This line starts just anterior to the anus and extends through the scrotum, continuing on the ventral surface of the penis. Same-day virtual video appointments and in-person appointments are available. there may be a light burning sensation as it appears, which last a few minutes. Certainly sounds that is need. Irritation of the urinary tract may cause pollakiuria and hemorrhage of the urinary mucosa. Anyone who hasn't been through it cannot appreciate the level of misery it causes. Age:22 Height:182cm Weight:60kg Race: Caucasian. Perineal Pain Perineal hematoma Urinary retention due to painful perineum. Method 1. A Verified Doctor answered. Deutsch: Anus einer einundzwanzigjährigen Frau English: The anus of a 21 year old woman with predominant raphe perinealis . 8 ± 3. 5%) (2,4). In many patients, no abnormalities are evident on physical examination. Its location may be related to anatomic characteristics of the perineum and median raphe. Prostate: The combination of perineal and penile pain often is due to low grade prostatitis. The perineum is the area between the scrotum and the anus in a man. Irritating, itchy, inflammatory bumps/fluffiness. Perianal region is an extremely rare location for these lesions. Use a perineal irrigation bottle to help clean or wash away any skin damage or sources of irritation. But in 70% of calls to a specialist, the main formulation of the diagnosis with such symptoms is "idiopathic itch of the anus". 5 month (range, 0. 1. 8. Vaginal discharge that smells bad. Here are some of the most common symptoms of a perineum cut. Hence, 41 patients were included in the study with 22 girls and 19 boys. To reduce the inflammation, you can apply a very small amount of 1% or 2% hydrocortisone ointment or cream, after bowel movements and twice a day, to the affected skin. The abscess may form after surgery or after delivery of a baby. Male: median raphe on ventral surface of bulb of penis; perineal body: Male:. But perineum pain can also be caused by injuries, urinary tract issues, infections, and other conditions. It does not hurt or itch, but it shouldn't be red. In males, the perineum is the area between the anus and the scrotum. Coccygodynia, sometimes referred to as coccydynia, coccalgia, coccygeal neuralgia or tailbone pain, is the term used to describe the symptoms of pain that occur in the region of the coccyx. Get your query answered 24*7 only on | Practo Consult. Depending on growth of the bulbospongiosus muscle and corpus spongiosus penis, the midline intermuscular septum obtained a connection to the subcutaneous wavy. Sit in 8 to 10 centimetres of warm water (sitz bath) for 15 to 20 minutes 3 times a day and after bowel movements. Tinea cruris is usually due to T. A few antibiotics and massages are used to treat perineal pain but are done only once the inflammation subsides. Home;. It is a basin-shaped muscular diaphragm that helps to support the visceral contents of the pelvis. 1. I have been itching around my vagina area- mostly the perineum and the skin around the anus for 5 months now. In most patients, the cysts, which are asymptomatic or unrecognized during childhood, may progress later and become symptomatic during adolescence or adulthood. 4 or pain in the testicle (not scrotum). It started out as an occasional itch, especially when i would sweat, but would go away after a day or so. Procedures Perineal Abscess Drainage;. Anal cancer: this is rare and is 20-30 times less common than colorectal cancer. Most reported cases of congenital perineal groove presented as an isolated defect in term or early-term singleton female infants. rubrum and presents as an asymmetrical erythematous patch with a scaly, annular border in the groin. The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). bot now i doubt it's something else. Median raphe cysts present anywhere between the external urethral meatus and the anus. A total of 43 children presented with perineal trauma to our institution during the study period. The ID Reaction is usually symmetrical too. They can be found from the distal penis and scrotum to the perineum in a. Created for people with ongoing healthcare needs but benefits. 0 rating. When to See a Doctor. Itching and pain. Perineal groove is a rare benign congenital anomaly with lesion that resembles perforation of mid-perineum or perineal raphe area. Fungal infection of skin is common in those area in. Perineal groove is a rare congenital malformation characterized by a midline wet erythematous sulcus of the perineal raphe extending from the posterior fourchette to the anterior edge of anus with a normal anatomy of urethra, vagina and anus. a very prominent midline perineal raphe extending from the site of the anal orifice to the scrotum [10]. Mine have really calmed down, and I have lots of. Perineal groove is a rare congenital midline malformation of the perineal raphe. Definition: Raphe means a line of fusion of the two halves of various symmetrical body parts, and the term median raphe refers to the perineal raphe, which is also known as the median raphe of the perineum; and it is divided anatomically to: penile raphe, scrotal and perineal raphae. Diagnosis can be made by taking some tissue (biopsy) and examining it under a microscope. Median raphe cysts can develop at any site along the midline of the ventral side of the male genital area, from the meatus to the scrotum and perineum (Figure 1). Common sites are midline of the ventral aspect of the urethra, glans, penile shaft (Fig. Perineal pain occurs adjacent to the anus. Perineal groove is a sulcus of mucosal tissue with clearly defined margins that can be found in the midline anywhere between the vagina and anus in girls, and rarely. Hunter Handsfield answered. It's situated between interior thighs and anal region. This structure continues through the midline of the scrotum (scrotal raphe) and upwards through the posterior midline aspect of the penis (penile raphe). 16. The perineum is the region below the pelvic diaphragm; it consists of muscle-fascial. R10. They can be found all the way from the distal penis and scrotum toward the perineum in a midline position. burning or itching around. 2. Continue Reading. It is completely common and normal physiological tissue line. Perianal candidal intertrigo presents as soreness and irritation with bright red erythema and satellite lesions extending into the natal cleft. Microscopic. Painful urination (pain when you pee). Several different injuries may cause pain in this area. The perineal body plays an important role in support of the vagina and in normal anal function. Congenital perineal groove is characterized by an exposed erythematous nonepithelized mucous membranes that resembles exposed wet erythematous sulcus, inflammation, or rupture of the midperineum area. Anatomy Name: The Intertrochanteric Line. 7, 1939. Perineum pain: Causes, treatments, and when to see a doctor. Pelvic and perineal pain. The incision is extended through the paired retractor penis muscles, the bulbospongiousus muscle, the corpus spongiosum penis, and urethral mucosa overlying the stallion catheter. The overall quality of evidence ranged from very low (for the outcomes postpartum maternal febrile morbidity and neonatal infection) to low (for the outcome maternal satisfaction and wound infection. Excision is the treatment of choice with minimal chance of recurrence. The red extends slightly into the upper scrotum. Types of perineal injuries. I accidentally cut my perineal raphe. Put a thin cloth between the ice and your skin. changes of the urothelium, secondary to irritation or local stimulation, has been described[14], which. In males, the perineum is the area which is situated between the scrotum and the anus, the pouch of the skin which holds the testicles. Perianal region is an extremely rare location for these lesions. The perineal raphe, septum, body, and fasciae are mainly constituted by contributions of the superficial and deep dorsal urogenital stroma. 143 yrs old Male asked about Left perineal pain since last 5 days, 5 doctors answered this and 201 people found it useful. See a doctor: By far the main cause of penile sores is herpes, especially when several sores or blisters appear at once. In men, however, the pain may be located in the perineum but may also radiate to the testes and the rectum. The perineal raphe is a visible line or ridge of tissue on the male human body that extends from the anus through theperineum. Press down towards the anus and the sides of your vaginal wall. Created for people with ongoing healthcare needs but benefits everyone. They may happen after hemorrhoids heal or cleaning that area too. Symptoms include perianal rash, itching and. Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions. The symptoms of perineum infection in females may include pain or discomfort in the perineum area, swelling or redness in the perineum area, itching or. This is called ‘idiopathic pruritus ani’ which means ‘itchy anus of unknown cause’. In this investigation we dissected 21 male and female large‐breed dogs. Call/text today: 1-212-204-6300 or make an appointment online. Before you try kegel exercises, make sure to empty your bladder. [3] Median raphe cysts can develop at any site along the midline of the ventral side of the male genital area, from the meatus to the scrotum and perineum (Figure (Figure1). Acute injuries include A perineal injury, or swollen perineum, will typically result in a feeling of throbbing pain, causing discomfort during movement and a few other activities. Intervals between panels are 0. Call/text today: 1-212-204-6300 or make an appointment online. Perineal pyramidal protrusion is a lump or protrusion of perineal tissue near the anus of some young children, usually girls. The cut itself is about 1/4 inch. My penile/scrotal raphe has been red for about three weeks. In contrast, in the human perineum between the scrotum and anus, the urorectal septum is most likely to provide the perineal raphe as in mice. It is the result of a fetal developmental phenomenon whereby the scrotum (the developmental equivalent of the labia in females) and. This is the American ICD-10-CM version of L02. 2. The diagnosis is clinical with histological confirmation. Scrotal raphe is a slightly elevated ridge of tissue running from the base of the penis to the midline of the perineum. central tendinous point and the midline raphe on the bulb of the penis. Infectious Disease 55 years experience. Most reported cases of congenital perineal groove presented as an isolated defect in term or early-term singleton female infants. Without effectively treating both aspects, perineum pain remains. Press down towards the anus and the sides of your vaginal wall. My perineum raphe is irritated and itchy, not at the rectal. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Penile/scrotal raphe is red. • Postural alterations. Not on my testicles but the last bit near the anus and about a couple centimeters up. anal pain or itching. Sir/ma'am I have a lump (painless) in perineal region, which is not visible from eyes or from surface. 1 mm (A–B, B–C), 0. He complained of several small but painful ulcers distributed along the under surface of the. Have a doctor drain fluid or pus from a cyst or an abscess. It's usually in response to a fungal infection (most common). Hold your thumbs in this position for about 1 minute. The pain is most commonly triggered in a sitting position, but may also occur when the individual changes from a sitting to standing position. The perineal muscles can be palpated, and tested for voluntary and reflex contraction. Noun [ edit] perineal raphe (plural perineal raphae) ( anatomy) The visible line that extends from the anus, through the mid-line of the scrotum and upwards through the posterior mid-line aspect of the penis. Board Certified Physician. Anatomy and function of the scrotum. PERINEAL WOUNDS FOLLOWING HIDERADENITIS SUPPURATIVA AND TRAUMA. This means that the cause of the itch is not found. The causes of perineal pain are pretty varied, but they fall into a few different categories. This is one of the most common areas of pain in men and women who suffer from various forms of pelvic pain. I know there is supposed to be a line there from the fusion of the two halves, however; mine have a excess of skin on mine. Untreated lichen sclerosus can also increase your chances of developing a type of skin cancer ( penile cancer and vulvar. All the patients presented with an unusual lesion at the anus or perineum, but no symptoms related to this anomaly. i am 21 and in good health, but for about three years now my perineum and the areas around it (scrotum and anus mainly) have been extremely itchy. Dr. You can find info on it online. General causes. [1]Lacerations on the perineum, cervix, vagina, and vulva can occur spontaneously or iatrogenically, as with an episiotomy. : perineums or perinea) in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The most common early complications were skin irritation (12%), pain associated with poor stoma location (7%) and partial necrosis (5%). D. In winters i had them rarely but now summer is starting & again bumps are appearing on my perineal raphe (outer back penis skin). Mycotic infection can present with annular lesions with scaly elevated borders and central clearing, or as a bright red rash in a “butterfly” distribution with. A healthy, 9-month-old Caucasian girl developed a smooth, tongue-shaped, 18- × 10-mm red lesion, localized in the midline of the perineum between the anus and vulva; there were multiple erosions and crusted papules on the perineum (Fig 2). 1. The cyst is generally solitary, with the penile shaft being the most common location, with average size of around 1 cm. deep branch of the perineal nerve (from pudendal nerve) perineal a. "i think i have a median raphe cyst. The tissue has been described as triangular, pyramidal, oval, tongue-shaped or leaf-shaped. 75m) Weight: 154 lbs (70kg) Race: Caucasian Duration of complaint: 1 hour Location: Scrotum. Introduction and hypothesis: Descending Perineum Syndrome (DPS) is a coloproctologic disease and the best treatment for it is yet to be defined. Pain in the area between the. The levator ani is a complex funnel-shaped structure mainly composed of striated muscle with some smooth muscle components. The 2024 edition of ICD-10-CM L02. This is especially true for people who have IBD, and in particular, Crohn's. Sit in 8 to 10 centimetres of warm water (sitz bath) for 15 to 20 minutes 3 times a day and after bowel movements. Perineal wounds can also occur following Fournier's gangrene, hideradenitis suppurativa, or in chronically bed ridden patients where pressure sores can extend into the perineal region. (A, E) The most anterior side of each series of photos. As the name suggests, perianal skin tags are soft growths that occur around the anus. Irritating, water/air type, itchy, inflammatory bumps/fluffiness. General. a rare congenital abnormality of failure of fusion of the perineal raphe and discussion. Constipation by itself can cause the pain that you have. How do you treat a perineal cyst? Use a sitz bath to relieve any pain, itching, or swelling in the perineum area. The perineum also protects the nerves used to urinate or have an erection. Treatments include creams, ointments, medications and home remedies. The diamond shaped perineum is divided into two triangles, the urogential triangle anteriorly and the anal triangle posteriorly. : Usually nerve irritation. Statistics. Perianal streptococcal dermatitis is a bright red, sharply demarcated rash that is caused by group A beta-hemolytic streptococci. However, during the past 5–6 years, the splitting had started in other parts of raphe covering the penis and scrotum. Very easy. DPS is frequently associated with pelvic organ prolapse (POP) and it is reasonable to postulate, that treatment of POP will also have an impact on DPS. Increased pain, swelling, redness, or warmth in the perineal area. Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. 6 7 14 Given that the perineal. Perineal groove is a rare anoperineal congenital malformation disease that usually affects newborn females. The most common treatment for perineal pain is rest; rest helps the body repair the damage. They develop when tissue becomes trapped near the median raphe nerve in your penis. It has been adapted as a robotic-assisted laparoscopic procedure and provides an alternative to perineal canal dissection in. Nov 22, 2021 at 1:46 AM. Do a search on this board for Vulvodynia. Introduction: Gonococcal infection of the penile raphe is rarely encountered in the clinical setting. 1 doctor answer • 1 doctor weighed in. We report the case of a newborn female with a perineal groove and review the limited literature. Perineal groove is a rare benign congenital anomaly with lesion that resembles perforation of mid-perineum or perineal raphe area. They are quite common and don't cause harm. Raphe means the line of union of the two halves of various symmetrical parts, and the term median raphe refers to the perineal raphe, which is also known as the median raphe of perineum. 225 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. area between the buttocks and genitals (perineum) area around the anus and rectum. [1]Lacerations on the perineum, cervix, vagina, and vulva can occur spontaneously or iatrogenically, as with an episiotomy. La protrusion pyramidale périanale est une entité d'individualisation récente, assez rare, touchant presque exclusivement le sexe féminin souvent en bas âge, d'origine congénitale, fonctionnelle ou associée au lichen scléroatrophique. Penile curvature. Because of the rarity, exact incidence cannot be calculated. Median raphe cysts of the perineum are uncommon congenital lesions of the male genitalia. I dont have insurance but went to the free clinic and the doc just said i have dry skin. [ 2] Median raphe cysts mostly present at birth and may remain asymptomatic or ignored during childhood. Even intense itching, if left alone, will subside after 5-10 minutes. These diseases are amenable to treatment. Although the incidence and pathogenesis of perineal groove is unknown, there is a clear female predominance. I have had a small hemroid for 14 years but it has never bothered me before so I don't think it's that. Abstract. Median raphe cysts can develop at any site along the midline of the ventral side of the male genital area, from the meatus to the scrotum and perineum (Figure (Figure1). It is mostly presented in female infants as an isolated anomaly but can be found in males as well []. Read More. It is unknown to many clinicians, which usually leads to misdiagnosis. Go to: Median raphe cyst is an uncommon anomaly that can develop at any location over the midline of the external genital region from the anus to the scrotum and perineum. As we have explored, it serves as a reminder of how all. Another plausible. We present a case and review the literature in respect to a 35-year-old man with a non-visible, painless midline swelling in the anterior perineum initially thought to be a liposarcoma. 2 Other symptoms include localized pain, chronic seepage, and excessive moisture. The median age at the first visit to our clinic was 1. This means that the cause of the itch is not found. Most are asymptomatic and are noted incidentally. Doctoral Degree. It is found in both males and females, arises from the fusion of the urogenital folds, and is visible running medial through anteroposterior, to the anus where it resolves in a small knot of skin of varying size. New or worsening stomach pain. Synonym(s): raphe perinei [TA]Perineal tearing and episiotomy (an incision in the perineum made by your doctor) are a common occurrence in vaginal delivery. Itching in the perineum is the main symptom for hemorrhoids, helminthic invasion or perineal fistula. The study aimed to understand the incidence, sites, clinical manifestations, and treatment of gonococcal infection of the penile raphe. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. Been having some pain in my perineum area when I push to pee and today when I was showering I felt a bump in that area that kind of felt like a harder pimple. This rare condition does not usually require surgical correction except for cosmetic reasons or if the. Asked for Male, 19 Years. Median raphe cysts present anywhere between the external urethral meatus and the anus. tight feeling in anus happens also. There are many Raphes in the human body. The body’s natural response is to form a scar where the tissues have torn. Synonyms: Pubovisceral muscle, Musculus pubovisceralis. perineal membrane and corpus cavernosum of the clitoris. This is due to the trauma placed on the perineal area during this process. The perineal raphe is a visible line or ridge of tissue on the human body that extends from the anus through the the area between the anus and the scrotum or vulva . The superficial dorsal urogenital stroma forms a complex which comprises elements forming the ventral perineal raphe, superficial perineal septum, and transverse dorsal stroma of the navicular fossa. Even intense itching, if left alone, will subside after 5-10 minutes. Resulting in a flap of skin down the perineal raphe. In males, the perineum sits just behind the scrotum and extends to the anus. The perineum is an erogenous zone. Perineal Tear. Excision is the treatment of choice with minimal chance of recurrence. 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