A 38 year old Asian lady presented with persistant itching in
the left areola of 2 years duration. It was diagnosed by her local doctor
as Eczema and treated with topical steroid cream. The condition did not respond
and ulceration in the areolar area occurred a year later.
On examination the appearances are shown below.
Yes.
There is a small ulcer in the left areola adjacent to the nipple at 10 o'clock
position
The areola around the ulcer shows scaling and excoriation. There
is peau d'orange change
This
is an instance of Paget's disease presenting as a dry scaly variant. Palpation
may confirm the presence of an underlying Carcinoma.
No.
The left breast is smaller than the right and is at a higher level.
The left nipple is also at a higher level than the right and is deviated away
from the midline
Learning Points
Paget's disease is more common than Eczema of the nipple
Eczema tends to be bilateral but Paget's disease is usually
unilateral
Diagnosis should be made by early biopsy
An associated breast cancer (in situ or invasive, palpable
or impalpable ) must be assumed to exist
Are the breasts and nipples symmetrical ? (Click
here for answer)
Are there any other changes in the nipples
and areolae ? (Click
here for answer)
What
are your conclusions ?
(Click here for answer)
Dr Uma Krishnaswamy MS, FRCSEd, FAIS, MA
Consultant General Surgeon
Email: umaks@vsnl.com
