Perianal Paget's disease is a rare condition and can be treated with wide local excision or abdominoperineal resection. In this video we present wide local excision of perianal Paget's disease. The patient is a 72 year old female who presented perianal rash that was treated with topical steroids for 2 years. She had a BMI of 32 and her past medical history was not significant for comorbidities. Wide local excision of perianal Paget's disease was performed and the defect was repaired with skin thickness grafts. Key technical points are presented in the video. There were no peri or post-operative complications and at outpatient follow-up eight months later, there was no recurrence and the patient had acceptable anal function with no incontinence. Wide local excision of perianal Paget's disease is feasible to perform with good outcomes.