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Paget Disease Nipple — SCE Medical Oncology MCQ

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ModerateBreast CancerPaget Disease NippleSCE Medical Oncology

A 60-year-old woman presents with an eczematous, crusted lesion of the nipple that has not responded to topical treatment for 3 months. Mammography shows no underlying mass. What is the most likely diagnosis and next investigation?

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Correct answer: D — Paget disease of the nipple — full-thickness punch biopsy of the nipple skin

Paget disease of the nipple presents as a persistent eczematous, crusted or eroded lesion of the nipple/areola that does not respond to topical treatment. It is associated with underlying DCIS or invasive carcinoma in >90% of cases, even when mammography is negative. Full-thickness punch biopsy showing Paget cells (large cells with clear cytoplasm, PAS-positive, HER2 often overexpressed) confirms diagnosis. MRI breast is recommended to assess the extent of underlying disease.

Reference: NICE NG101 Early breast cancer; ESMO 2024 Early Breast Cancer Guidelines