Dermatology - Mammary Paget Disease

Dermatology - Mammary Paget Disease 
Mammary Paget disease is a malignant tumor that mimics a persistent eczematous dermatitis and affects the nipple or areola unilaterally. It typically affects women over 50 and is indicative of the continuous spread of underlying intraductal carcinoma of the breast, which accounts for 1-4 percent of breast cancer cases. Men are not without uncommon examples. It develops slowly over a few months or years.

Itching, soreness, burning, discharge, bleeding, ulceration, and nipple invasion are possible symptoms.

Skin lesions are oval, red, scaling plaques that may be bilateral in nature and have sharp margins. The surface is wet and dripping once the scale is removed.
The size of lesions varies from 0.3 to 15 cm. Early on, the plaque is not indurated; subsequently, it becomes indurated and infiltrated, and nodules may be felt in the breast. Less than half of patients have a palpable underlying breast lump at initial presentation.
When there is a palpable mass beneath the lesion, lymph node metastases happen more frequently.

A biopsy that reveals cancerous cells in the epidermis that are spreading in a pathognomonic way confirms the diagnosis. Use mammography to identify underlying intraductal cancer.
The differential diagnosis consists of squamous cell carcinoma in situ, hereditary pemphigus, nippleareola retention hyperkeratosis, psoriasis, eczematous dermatitis, and benign ductal papilloma. The majority of the time, bilateral nipple eczematous dermatitis is non-induring and reacts quickly to topical glucocorticoids. However, if the "eczema" lasts longer than three weeks, be on the lookout for Paget illness.

Treatment options include surgery, radiation, and/or chemotherapy, much like with other types of breast cancer. If palpable regional nodes are found, dissect the lymph nodes. The prognosis differs. 92% of patients survive 5 years following excision if the breast lump is not perceptible, and 82% survive 10 years.
Of those with palpable breast mass, 38% live for five years and 22% for ten. When lymphadenopathy is present, the prognosis is worse.