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An epithelioid hemangioendothelioma and Paget's disease of the breast were treated with topical imiquimod 5% cream with very impressive results. In both of the tumors complete disappearance of the lesions occurred. In this article, in addition to describing the treatment approach, the findings in biopsy specimens of the epithelioid hemangioendothelioma and the Paget's disease before, during, and after therapy will be described. The histologic findings show ample evidence that there is both a lymphocytic T helper 1-like and T helper 2-like response from imiquimod. Direct evidence of lymphocytotoxicity was found. Furthermore, mast cells appear to be involved in the development of regression in the vascular tumor. Although the study is very limited and reports only two cases, the results are striking. We considered it important to describe these findings because of their possible use in developing strategies for the application of imiquimod in the treatment of other tumors in human beings.

From Sc U Ta Sc Fund Conf Corre D CLINICAL PRESENTATION A 75-year-old Asian woman presented with a 2-year history of pruritus of the left nipple. The physical examination revealed a large, mildly hyperkeratotic plaque affecting the left nipple and areola region with irregular pigmentation, border, and nipple flattening (Fig 1). The remainder of the medical history and physical examination was unremarkable.

Paget's disease of the breast presents as an eczematous lesion of the nipple. Histologically, it is characterized by malignant intraepidermal cells associated with an underlying ductal carcinoma. Paget's disease of the male breast is rare. Although melanin has been found within the malignant cells of Paget's disease, no clinically pigmented lesion has yet been reported. We present a case of pigmented Paget's disease of the male breast and review the pathogenesis of this disease.

Erosive adenomatosis of the nipple (EAN) is a rare, benign neoplasm of breast lactiferous ducts. Peak incidence is in the fifth decade in women. Clinically, it may be mistaken for Paget's disease and, histologically, for adenocarcinoma. Some authors have proposed an association with breast carcinoma and fibrocystic breast changes. Erosive adenomatosis of the nipple is extremely rare in children. Treatment is usually local excision of the nipple. This is the first formal English language case report of EAN in the pediatric age group. It is important for dermatologists to be familiar with this entity to prevent unwarranted breast removal.

Paget's disease of the breast is a rare condition with an incidence of 3% to 5% of all mammary malignancies. Of all malignant breast cancer, 1% occurs in male patients, and thus, Paget's disease of the male breast is extremely rare. We present a case of intraductal carcinoma of the male breast presenting as Paget's disease.

Paget's disease of the breast is a malignant lesion consisting of Paget cells in the epidermis and an underlying ductal carcinoma of the breast tissue. It is estimated that perhaps 3% of female breast carcinoma cases are Paget's disease. If one estimates male breast carcinoma to be approximately 1% of the rate in the female population, then Paget's disease in men is clearly a rare clinical event. Although Paget's disease has an epidermal component, little attention has been given to this entity in the dermatologic literature. We present a case report of this disease in an elderly male patient and comment on the clinical features which should alert the physician to the presence of the malignancy.

We report the coexistence of pemphigus vulgaris and Paget's disease of the nipple in a patient with a documented history of pemphigus and a 2-year complaint of an eczematous breast lesion. A biopsy taken from the lesion showed the characteristic histologic features of both pemphigus and Paget's disease of the nipple. Immunohistochemical technics revealed intercellular IgG deposits characteristic of pemphigus and intracellular staining with antibody to epithelial membrane antigen in the cytoplasm of Paget's cells. This report is the first describing the coexistence of these two distinct disease entities in one tissue sample. This case underscores the necessity of early biopsy of recalcitrant nipple lesions even in the presence of another, well-documented skin disorder.