Mammary Paget disease
Mammary Paget disease is an uncommon skin cancer characterised by a chronic eczema-like rash of the nipple and adjacent areolar skin. It is also called Paget disease of the nipple.
Mammary Paget disease is most commonly diagnosed between 50 and 60 years of age. It is much more common in women than in men.
Mammary Paget disease is associated with an underlying cancer, either in situ adenocarcinoma of the breast or a more widespread infiltrating cancer, although this is sometimes difficult to detect on clinical examination or by mammogram.
A similar condition that involves the skin of female and male genitalia is known as extramammary Paget disease.
What are the signs and symptoms?
Most patients go to their doctor complaining of an itchy, burning rash on and around the nipple area. Sometimes the skin may be broken and sore from itching. Other symptoms include:
- Oozing nipple discharge
- Bloody nipple discharge
- Inversion of the nipple
Scaly, crusty and thickened plaques often form on the nipple, which then spreads to the surrounding area. Usually only one nipple is affected although rare cases of involvement of both nipples has been seen.
Diagnosis of mammary Paget disease
Skin biopsy of the lesion is performed for accurate diagnosis of mammary Paget disease. Under the microscope, the presence of Paget cells along with other histological findings confirms diagnosis. Skin biopsy may also determine whether there is underlying cancer, although some breast carcinomas are not seen because they are situated more deeply in the breast tissue. A mammogram may be performed to accurately locate the underlying cancer prior to breast biopsy.
What is the treatment of mammary Paget disease?
Mastectomy (removal of the breast) is often necessary treatment for mammary Paget disease. Alternatively, it can be widely locally excised along with samples of tissue taken from nearby lymph nodes in the armpit. Sometimes conservative treatment such as partial nipple excision, wedge excision, cone excision, radiotherapy, or a combination of these may be used in women with less advanced stages of the disease. However, recurrence is common in these cases.
- Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.
On DermNet NZ:
- Mammary Paget Disease – Medscape Reference
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