Hyperkeratosis of the Nipple and Areola Workup

  • Author: Joseph C English III, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 20, 2010
 

Laboratory Studies

No blood or urine laboratory tests aid in the diagnosis of primary hyperkeratosis of the nipple and/or areola (HNA).

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Imaging Studies

Imaging studies must be performed if any concern about underlying breast disease exists. Mammography should be performed, with or without ultrasonography. Ultrasonography of the nipple may demonstrate skin thickening.[25]

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Other Tests

In cases of secondary hyperkeratosis of the nipple and/or areola, additional testing may be required. Malignant acanthosis nigricans associated hyperkeratosis of the nipple and/or areola requires possible endoscopy and/or colonoscopy and CT scanning. Cutaneous T-cell lymphoma–associated blood testing for clonality and CT scanning for staging may need to be performed.

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Procedures

The acquisition of a skin biopsy sample for histopathologic examination aids in differentiating nevoid hyperkeratosis of the nipple and/or areola from other conditions. The preferred method involves a 3- or 4-mm punch biopsy followed by closure with 6-0 Prolene sutures. An alternative suture material (eg, 5-0 or 6-0 plain gut [absorbable] suture) may be used if desired. This method provides the best cosmetic results, with minimal scarring and maintenance of the normal architecture of the nipple and/or areola.

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Histologic Findings

Primary hyperkeratosis of the nipple and/or areola is characterized by variable orthokeratotic hyperkeratosis, slight acanthosis, and marked papillomatosis changes on routine hematoxylin and eosin–stained specimens. Additional findings reported include mild dermal lymphocytic perivascular inflammation[23, 26, 27] and epidermal spongiosis with microabscesses with normal lymphocytes.[28, 29] Clonal analysis of the lymphocytes is negative.[29]

In secondary hyperkeratosis of the nipple and/or areola, biopsy samples may reveal histologic findings related to the associated skin disease. An example includes cutaneous T-cell lymphoma–associated hyperkeratosis of the nipple and/or areola histology, which reveals epidermotropism with atypical lymphocytes.[15]

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph C English III, MD  Clinical Vice-Chairman for Quality and Innovation, Associate Professor of Dermatology, Department of Dermatology, University of Pittsburgh

Joseph C English III, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Kathryn Schwarzenberger, MD  Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care

Kathryn Schwarzenberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, American Dermatological Association, Dermatology Foundation, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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An adult male with bilateral primary hyperkeratosis of the nipple and areola
A close-up of the patient's right nipple/areola complex.
A close up of the patient's nipple/areola complex.
 
 
 
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