Paget Disease of the Breast

  • The clinical hallmarks of Paget’s disease of the breast are:
    • Scaling, erythema, and / or ulceration of the nipple sometimes extending to the areola
  • Because the main differential diagnosis for this clinical presentation is eczema:
    • A short course of topical steroids is an appropriate initial step:
      • Failure to resolve should prompt tissue biopsy by punch or wedge technique and not additional steroid therapy
  • Pathology revealing adenocarcinoma cells within the epidermis (Paget cells):
    • Confirms the diagnosis
  • HER2 amplification:
    • Is found in 60% to 90% of cases of Paget’s disease of the breast:
      • But the patient should be fully evaluated prior to making decisions regarding the need for targeted therapy
  • Appropriate diagnostic imaging includes:
    • Mammography, ultrasound, and / or breast MRI:
      • As Paget’s disease is associated with an underlying malignancy 85% of the time
  • The appropriate surgical management of Paget’s disease is:
    • Breast conservation with central mastectomy (resection of the nipple-areolar complex) with resection of the primary tumor and irradiation or mastectomy
  • References
    • Chen CY, 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.
    • Killelea BK, Chagpar AB, Horowitz NR, Lannin DR. Characteristics and treatment of human epidermal growth factor receptor 2 positive breast cancer: 43,485 cases from the National Cancer Database treated in 2010 and 2011. Am J Surg. 2017;213(2):426-432.
    • Caliskan M, Gatti G, Sosnovskikh I, et al. Paget’s disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat. 2008;112(3):513-521.

#Arrangoiz #BreastSurgeon #CancerSurgeon #PagetDiseaseoftheBreast #CASO #CenterforAdvancedSurgicalOncology #Miami

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