Dermatology Online Journal

Melanoma of the nipple mimicking Paget's disease
Chien-Hua Lin¹, Herng-Sheng Lee², Jyh-Cherng Yu¹
Dermatology Online Journal 13 (2): 18

1. Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense MedicalCenter, Taipei, Taiwan, Republic of China. doc20106@ndmctsgh.edu.tw2. Department of Pathology, Tri-Service General Hospital,National Defense Medical Center, Taipei, Taiwan, Republic of China

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Mammary Paget's disease occurs on the nipple-areola complex and may spread to surrounding skin. It was initially described in 1874 by Sir James Paget [1]. The typical clinical presentation includes itching, erythema, scale, erosion, and nipple drainage [2]. We present an elderly woman patient with melanoma of the nipple that had the gross appearance of Paget's disease.

Clinical synopsis

Figure 1
Scaly, erythematous, crusty, pigmentation and thickened plaques on the nipple, spreading to the surrounding areolar areas

An 86-year-old woman presented with persistent, erythematous, ulcerative changes of her left nipple for several months. Physical examination showed a scaly, erythematous, crusty, and thickened plaque with some hyperpigmentation on the nipple. Erythema and scale extended onto the surrounding areolar area (Fig. 1). Bleeding from the nipple occurred off and on for two months. Paget's disease was the initial clinical impression. Chest X-ray, bone scan and liver ultrasonography showed no evidence of metastasis. The patient underwent wide excision. The pathology confirmed nodular melanoma (Figs. 2 and 3). No recurrence was observed during a 6-month follow-up.

Figure 2	Figure 3
Pathology showing melanoma, nodular type, with frequent abnormal mitoses, epithelial involvement and focal hemorrhage. (A: HE x200, B: HMB45 x200)

Discussion

Melanoma of the nipple is quite uncommon; most of the cases are metastatic [3]. Furthermore, this tumor is relatively uncommon in Asian patients. Paget's disease of the nipple would be more common in Asian populations and may be hyperpigmented. Therefore the correct diagnosis requires histological interpretation [4]. Although rare, melanoma of the nipple may mimic Paget's disease.

References

1. Paget J. Disease of the mammary areola proceeding cancer of the mammary gland. St Bat Hosp Rep 1874;10:87-89

2. Paone J, Baker K, Huvos A. Pathogenesis and treatment of Paget's disease of the breast. Cancer 1981;48:825-29

3. Ravdel L, Robinson WA, Lewis K, Gonzalez R. Metastatic melanoma in the breast: a report of 27 cases. J Surg Oncol 2006;94:101-4

4. Papachristou DN, Kinne D, Ashikari R, Fortner G. Melanoma of the nipple and areola. Br J Surg 1979;66:287-8

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