Mammary Paget Disease Differential Diagnoses

Updated: May 14, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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DDx

Diagnostic Considerations

Proper recognition of mammary Paget disease (PD) is required to initiate an appropriate workup (eg, skin biopsy) for differentiating it from other benign inflammatory dermatoses and for detecting an underlying breast carcinoma. Early dermatologic consultation and a tissue biopsy of the lesion on the nipple and/or the areolar area are necessary for accurate diagnosis of mammary PD. Regular mammographic examinations aid in early detection of in situ and invasive breast cancer. A newer development in the diagnosis of mammary Paget disease is the use of reflectance confocal microscopy, which Guitera et al and others concluded is likely to facilitate earlier diagnosis of Paget disease and the instigation of appropriate management with concomitant improvement in clinical outcomes. [22, 23]

Other problems to be considered include the following:

  • Nipple duct adenoma: It usually is evident as a palpable nipple nodule with cutaneous erosion and sometimes a discharge in middle-aged women. [24] Rarely, there may be no nipple involvement. [25]

  • Erosive adenomatosis of the nipple (a benign neoplasm of the major nipple ducts)

  • Benign Toker cell (clear cell of the nipple epidermis) hyperplasia

  • Malignant melanoma in situ

Other mimics include basal cell carcinoma, a variety of infections including schistosomiasis, tattoo complications, atopic dermatitis, factitial dermatitis, and other forms of eczema. [26]

Differential Diagnoses