Paget's disease of the nipple may be the first sign of an underlying breast carcinoma. It is important that the woman be promptly evaluated and not treated casually.
Clinical features of Paget's disease of the nipple:
(1) It most often occurs in a woman > 50 years of age.
(2) The nipple and areolar complex are erythematous and crusted.
(3) There may be evidence of nipple destruction.
(4) There is no improvement after a 4 week trial of topical corticosteroid cream.
Features favoring the presence of an underlying malignancy:
(1) bloody nipple discharge
(2) family history of breast cancer
(3) palpable breast mass
Differential diagnosis:
(1) eczema
(2) contact allergy (nipple ring, other)
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