A 58-year-old woman presents with burning, itching, and scaling skin around her areola

referral to a breast surgeon for possible small excisional biopsy of areolar tissue to rule out Paget disease and associated ductal carcinoma in sit

Educational Objective:

Diagnose Paget disease of the breast.

Key Point:

Paget disease of the breast is an eczematous lesion of the nipple and areola areas associated with an underlying breast carcinoma.

Explanation:

This clinical presentation is consistent with Paget disease of the nipple, which, in the majority of cases, is associated with an underlying malignancy (in situ or invasive breast cancer) upon further radiographic evaluation. Duct ectasia is possible and is associated with itching and burning, but it is usually accompanied by multiduct nipple discharge with or without nipple inversion and without significant inflammatory findings. Lobular carcinoma in situ is usually not detectable by clinical examination and is more often an incidental finding in a breast biopsy specimen.

References:

Alvero R, Paget’s disease of the breast. In: Ferri FF. Ferri's Clinical Advisor. 2017:915.

Harris JR, et al, eds. Diseases of the Breast. 5th ed., 2014.