Photo Quiz

A Resolving Rash on the Breast

 

Am Fam Physician. 2016 Feb 15;93(4):297-298.

A 54-year-old woman presented with a non-pruritic rash on her nipple for the past three months. It began as a large plaque covering approximately one-fourth of the breast, but gradually decreased to a small plaque affecting only the nipple. She had occasional spontaneous milky discharge from the nipple. She had normal mammographic findings the previous month and no family history of breast cancer.

Physical examination revealed a small pink plaque with scale on the left nipple. Compared with the unaffected side, there was a noticeable flattened appearance and loss of the normal Montgomery tubercles of the areola (Figures 1 and 2). There were no palpable breast masses or other similar skin plaques.

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Figure 1.

Affected side.


Figure 1.

Affected side.

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Figure 2.

Unaffected side.


Figure 2.

Unaffected side.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Eczema.

B. Paget disease.

C. Papillary adenoma.

D. Psoriasis.

Address correspondence to Maria LaPlante, MD, at mjl2t@virginia.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Kothari AS, Beechey-Newman N, Hamed H, et al. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer. 2002;95(1):1–7....

2. Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget's disease of the nipple. Breast Cancer Res Treat. 2013;141(1):1–12.

3. Masters RK, Robertson JF, Blamey RW. Healed Paget's disease of the nipple. Lancet. 1993;341(8839):253.

4. Whitaker-Worth DL, Carlone V, Susser WS, Phelan N, Grant-Kels JM. Dermatologic diseases of the breast and nipple. J Am Acad Dermatol. 2000;43(5 pt 1):733–751.

5. Chen C, Sun LM, Anderson BO. Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer. 2006;107(7):1448–1458.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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