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| Fig. 35.6 Paget’s disease. Sharply demarcated area of erythema and scale crust that had been treated as a dermatitis, showing partial destruction of the nipple. The patient had an underlying ductal breast carcinoma. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
On the female breast, although cases have been reported in men. It begins as a small eczematous patch on the nipple that gradually spreads onto the areola and eventually to the skin of the breast. The borders of the lesion are sharply marginated, and the surface may be crusted, moist, erythematous, and/or scaly (Fig. 35-6). Paget’s disease of the breast invariably has an underlying ductal carcinoma, although often there is no breast mass and mammograms can be normal. Any chronic eczematous lesion on the nipple or areola that is unresponsive to topical therapy should have an excisional biopsy, which includes nipple ducts and underlying breast tissue. The associated ductal carcinoma may be small and focal and is easily missed by small punch or shave biopsy.
Extramammary Paget’s disease occurs on the axilla, groin, or anogenital skin. The disease may present with solitary or multiple lesions. It is often associated with an underlying adnexal carcinoma, and about 20% of cases have carcinoma of the rectum or genitourinary tract.
Kao GF: Paget disease, mammary,
eMedicine Online November 2007.
