The number of CD8+ T cell infiltration in noninvasive and invasive EMPD is similar; however, the number of CD8+ T cell-expressing granulysin and perforin is relatively lower in invasive EMPD than that of noninvasive EMPD, signifying the presence of stronger immunosuppression in the tumor microenvironment of invasive EMPD than noninvasive EMPD (49). This evidence concerns the gene PRF1 and extramammary Paget disease.