Paget's Disease of the Nipple

Question 1

What is it?

Answer 1

A rare condition that presents as roughening, reddening and slight ulceration of the nipple.

It will usually 97% have an underlying neoplasm, in situ or invasive.

Question 2

Microscopical finding

Answer 2

Involvement of the epidermis by malignant ductal carcinoma cells

Question 3

Clinical features

Answer 3

Itching or redness in the nipple +/- areola

Flaking and thickened skin

Area often painful and sensitive

Can have a flattened nipple with or without yellowish or bloody discharge

Question 4

Dx

Answer 4

Dermatitis

Eczema

Question 5

Investigations

Answer 5

Biopsy needed to confirm diagnosis

Entire nipple might have to be removed for histological examination

Breast and axilla exmination should also be performed

Mammograms, USS or MRI breast may also be warranted

Question 6

Management

Answer 6

First line is surgery with removal of nipple and areola.

Radiotherapy might be needed