Paget’s Disease of the Breast
A 44-year-old woman presented to the clinic dermatology with a 1-year history of an itchy skin lesion on the right nipple and intermittent nipple discharge. On physical examination, there was a well-demarcated, dark-pink plaque over the entire nipple–areola complex on the right side. The lesion had a raised, irregular margin, as well as overlying crusting and excoriation (Panel A). Dermoscopy of the lesion showed superficial furrows and scaling (Panel B). There was no palpable breast mass or axillary lymphadenopathy. A punch biopsy of the lesion revealed malignant, intraepithelial adenocarcinoma cells — also known as Paget cells (Panel C, arrows; hematoxylin and eosin staining). A diagnosis of Paget’s disease of the breast was made. Paget’s disease of the breast is an uncommon manifestation of breast cancer that develops in the skin of the nipple. It is usually associated with underlying ductal carcinoma in situ or invasive ductal carcinoma. Diagnosis may be challenging because the lesion often resembles benign conditions, such as eczema. Magnetic resonance imaging of the right breast showed ductal carcinoma in situ in the areola. Treatment with nipple–areola resection and wide local excision followed by radiotherapy was completed. At 1 year of follow-up, there was no evidence of recurrence.