Paget’s disease of the breast or nipple is a malignant condition that usually affects only one breast. It is named after Sir James Paget, the surgeon who first described the condition. The outward appearance of Paget’s is similar to eczema with a dry, scaling appearance of the nipple and areola of the breast. Eczema of the nipple or breast usually affects both breasts and this is an important differentiation between the two conditions.
The condition starts on the nipple then spreads to the areola (the darker skin immediately surrounding the nipple) and if untreated onto the breast itself. The skin may feel itchy and be red or inflamed. The nipple may have a fluid discharge and may be inverted or appear dimpled. The appearance of Paget’s disease can also wax and wane giving the appearance of improving or healing even though the condition is in fact worsening. This often leads to a delay in diagnosis since individuals may mistakenly think the condition is improving. Paget’s disease is almost always associated with an underlying invasive breast cancer. It is more common in women and generally speaking individuals who develop Paget’s Disease are over age 50. It is most commonly associated with underlying invasive breast cancer or ductal carcinoma in-situ of the involved breast.
Diagnosis is made by biopsy and mammogram although fluid from any discharge from the nipple can also be used to confirm the diagnosis.
Treatment is similar to any breast cancer. This utilizes surgery to remove the cancerous tissue and may possibly use chemotherapy and radiation therapy. Prognosis for the condition depends on the stage at which it is first diagnosed and treated. Metastatic disease, where the cancer has spread to lymph nodes or beyond the breast lowers the survival rates significantly.
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