Paget Disease Of The Nipple

• Paget Disease Of The Nipple is a rare breast cancer affecting the nipple and areola.
• It typically presents with skin changes such as redness, scaling, itching, and crusting.
• The condition is almost always associated with an underlying ductal carcinoma in situ or invasive breast cancer.
• Diagnosis involves clinical examination, imaging, and a definitive biopsy of the affected skin.
• Early detection is crucial for effective treatment and improved outcomes.

What is Paget Disease Of The Nipple?

Paget Disease Of The Nipple is a rare form of breast cancer that manifests as a skin condition affecting the nipple and the dark circle of skin around it, known as the areola. This condition is distinct from Paget’s disease of bone. It is characterized by the presence of Paget cells, which are cancerous cells that migrate from an underlying tumor within the breast ducts to the surface of the nipple and areola. While relatively uncommon, accounting for approximately 1-4% of all breast cancers, it is crucial to recognize its symptoms as it nearly always signifies an underlying breast malignancy, either ductal carcinoma in situ (DCIS) or invasive breast cancer.

Symptoms and Causes of Paget Disease Of The Nipple

The symptoms of Paget disease nipple can often be mistaken for benign skin conditions like eczema or dermatitis, leading to delayed diagnosis. These symptoms typically affect only one nipple and may include:

• Redness, scaling, or flaking of the nipple and/or areola.
• Itching, tingling, or burning sensations in the affected area.
• Crusting, oozing, or bleeding from the nipple.
• A sore or lesion on the nipple that does not heal.
• Thickening of the skin on or around the nipple.
• Nipple inversion or flattening.

The primary causes of Paget’s disease of nipple are believed to stem from an underlying breast cancer. The most widely accepted theory suggests that cancer cells (Paget cells) originate from a tumor deeper within the breast’s milk ducts and then travel along these ducts to the skin surface of the nipple and areola. Less commonly, it is hypothesized that the skin cells of the nipple and areola themselves undergo cancerous transformation independently. Regardless of the exact mechanism, the presence of Paget Disease Of The Nipple is a strong indicator of an underlying carcinoma, which can be either non-invasive (ductal carcinoma in situ) or invasive breast cancer.

Diagnosing Paget Disease Of The Nipple

A timely and accurate Paget’s disease of the breast diagnosis is critical due to its association with underlying breast cancer. The diagnostic process typically begins with a thorough clinical examination, where a healthcare provider inspects the nipple and areola for any characteristic skin changes. If Paget Disease Of The Nipple is suspected, several diagnostic tests are usually performed:

Imaging studies are essential to assess for an underlying tumor within the breast. These may include:

• Mammogram: To screen for any masses or calcifications in the breast.
• Ultrasound: Often used to further evaluate any suspicious areas found on a mammogram or felt during examination.
• MRI (Magnetic Resonance Imaging): May be recommended for a more detailed view of the breast tissue, especially if other imaging results are inconclusive.

The definitive diagnosis, however, relies on a biopsy of the affected skin. A punch biopsy, which removes a small sample of the nipple or areola skin, is commonly performed. This tissue sample is then examined under a microscope by a pathologist to identify the presence of Paget cells, confirming the diagnosis. Early diagnosis and subsequent treatment are vital for improving patient outcomes.