EC Gynaecology

The clinical examination of nipple-areolar plaques is an integral part of breast screening evaluation. Any persistent unilateral lesion of the nipple should warrant particular attention and investigation for Paget's disease of the nipple. Its diagnosis is made by cytological scraping of the nipple. This is a rare variant of ductal carcinoma in situ. Breast evaluation should look for underlying breast tumors, present in more than 80% of cases, as well as multifocal tumors, which occur with high frequency. Preoperative breast MRI is useful if conservative surgery is being considered due to a higher incidence of occult cancer on mammography and ultrasound. Erosive adenomatosis of the nipple is benign but can mimic pure Paget's disease of the nipple. More rarely, pagetoid basal cell carcinoma, Bowen's disease and melanoma are clinically difficult to differentiate and share with Paget's disease the unilateral nature and chronicity of the evolution. The biopsy allows the diagnosis to be made. Skin extension of breast carcinoma is rare and should be suspected in cases of nipple retraction and/or fixed nipples. Eczema is different in the bilateral nature of its lesions, the absence of deformation of the nipple, the progression by flare-ups and its regressive nature under local corticosteroid therapy.

 Keywords: Paget’s Disease of the Nipple; Symptoms; Therapeutic Attitude; Clinical Case

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