Paget’s Disease

Paget’s disease is a rare presentation of breast cancer. It presents with itching and bleeding of the nipple or areola and yellowish exudates or ulceration may be present. Ninety percent of patients are found to have DCIS or invasive breast cancer as the underlying pathology. Full-thickness skin biopsy is recommended for diagnosis of Paget’s. Diagnostic imaging includes mammography and ultrasound to detect an associated lesion in the breast. MRI is recommended if these do not demonstrate a cancer or to evaluate the extent of the disease for surgical planning. Surgical treatment depends on the location of the cancer within the breast which may not always be in the vicinity of the nipple areolar complex. Sentinel node biopsy is recommended if the surgical treatment is going to be mastectomy or if there is evidence of invasive disease on biopsy. If a patient has isolated Paget’s disease of the nipple, the surgical management options include central lumpectomy with or without sentinel node biopsy and radiation or mastectomy with sentinel lymph node biopsy.