Articles
| Open Access |
DOI: Paget’s Disease of the Breast, underlying breast cancer mimicking as Benign Dermatological Conditions: Clinical Challenges and Diagnostic Considerations
Muhammad Nouman Tariq , International Center of Medical Sciences Research (ICMSR), Islamabad PAKISTAN Akhtar Saeed Medical and Dental College Insha Aleena , Mahatma Gandhi Medical College and Research Institute (Sri Balaji Vidyapeeth University) Akeel Ahamed Salahudeen , Nishtar Medical University, Multan Sundas Asif , Yusra Medical and Dental College/Bahria University Islamabad Maryam Kiani , Bannu Medical College Arshi Wasim , Calcutta National Medical College Khushbu Komalbhai Patel , Our Lady of Fatima University, Philippines Zurnish Rauf , Jinnah Hospital, Lahore, Pakistan Letterkenny University Hospital, Donegal, Ireland Umar Jamshed Qureshi , Akhtar Saeed Medical and Dental College Rizwan Uppal , Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad PAKISTAN Muhammad Rehan Uppal , Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad PAKISTAN Umar Saeed , Foundation University Islamabad (FUI), Islamabad PAKISTAN Zahra Zahid Piracha , International Center of Medical Sciences Research (ICMSR), Islamabad PAKISTAN International Center of Medical Sciences Research (ICMSR), Austin, TX, United States of America International Center of Medical Sciences Research (ICMSR), Chadwell Heath, United Kingdom Muhammad Ahmad , from NISHTAR MEDICAL COLLEGE MULTAN Muhammad Zeeshan Tariq , University of Huddersfield.Abstract
Mammary Paget's disease (MPD), also known as Paget's disease of the breast, is an uncommon dermatological cancer of the nipple-areolar complex that can cause anything from redness and itching to more serious symptoms like breast lumps, destruction of the nipple-areolar complex, or nipple discharge. It is typically linked to either invasive ductal carcinoma or an underlying ductal carcinoma in situ. MPD can cause delayed diagnosis and improper therapy because it frequently presents as various benign and malignant dermatological disorders, such as eczema, atopic dermatitis, psoriasis, and squamous and basal cell carcinomas. Since only one-third of patients have a palpable lump when they first arrive, MPD should be suspected in patients who are older and have unilateral, persistent lesions. In order to distinguish MPD from other skin illnesses, our review paper highlights the major findings of clinical features and diagnostic workup. It also includes case studies of MPD mimicking other skin conditions. According to a study of the literature, research advises against using mammograms and ultrasounds alone to diagnose MPD, especially when there isn't a palpable lump. This demonstrates that the MRI is a better and more precise imaging method. However, because MRI results can occasionally be negative when there is a biopsy-proven MPD present, any suspicious lesion needs to be biopsied in order to undergo histological and immunohistochemical analysis. This highlights the need for clinicians to explore any suspicious lesion of the nipple or breast using the complete triple evaluation technique to exclude an underlying cancer. It is vital to establish therapeutic criteria to treat any nipple lesion to limit the risk of misdiagnosing any underlying cancer, which can be potentially lethal if left alone.
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References
Avcı T, Yabanoğlu H, Erkent M, Börcek P, Kuş M. Paget’s disease of the breast: clinical-pathological findings and surveillance. J Cukurova Anesth Surg. 2020;3:230-8.
Markarian S, Holmes DR. Mammary Paget's disease: an update. Cancers (Basel). 2022;14:2422. doi:10.3390/cancers14102422.
Yasir M, Khan M, Lotfollahzadeh S. Mammary Paget disease. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
Karakas C. Paget's disease of the breast. J Carcinog. 2011;10:31. doi:10.4103/1477-3163.90676.
Dubar S, Boukrid M, Bouquet de Joliniere J, et al. Paget’s breast disease: a case report and review of the literature. Front Surg. 2017;4:51. doi:10.3389/fsurg.2017.00051.
Ooi PS, Draman N, Yusoff SS, Zain WZ, Ganasagaran D, Chua HH. Mammary Paget’s disease of the nipple: relatively common but still unknown to many. Korean J Fam Med. 2019;40:269-72. doi:10.4082/kjfm.17.0143.
Barth D. Bilateral Paget’s disease of the breast-case report of long-time misdiagnosed tumors with underlying ductal carcinomas and review of the literature. Case Rep Dermatol Med. 2014;2014:152836. doi:10.1155/2014/152836.
Lim HS, Jeong SJ, Lee JS, et al. Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics. 2011;31:1973-87. doi:10.1148/rg.317115070.
Matamoros-Parra LJ, Vertel-Velásquez MA, Camargo-Villalba GE. Paget’s disease of the breast without associated ductal carcinoma: case report and review of the literature. Rev Colomb Obstet Ginecol. 2019;70:58-67. doi:10.18597/rcog.3193.
Geffroy D, Doutriaux-Dumoulins I, Labbe-Devilliers C, et al. Paget's disease of the nipple and differential diagnosis (Article in French). J Radiol. 2011;92:889-98. doi:10.1016/j.jradio.2011.07.010.
Ashikari R, Park K, Huvos AG, Urban JA. Paget's disease of the breast. Cancer. 1970;26:680-5. doi:10.1002/1097-0142(197009)26:33.0.co;2-p.
Fu W, Lobocki CA, Silberberg BK, Chelladurai M, Young SC. Molecular markers in Paget disease of the breast. J Surg Oncol. 2001;77:171-8. doi:10.1002/jso.1090.
Hanna W, Alowami S, Malik A. The role of HER-2/neu oncogene and vimentin filaments in the production of the Paget's phenotype. Breast J. 2003;9:485-90. doi:10.1046/j.1524-4741.2003.09610.x.
Guarner J, Cohen C, DeRose PB. Histogenesis of extramammary and mammary Paget cells. An immunohistochemical study. Am J Dermatopathol. 1989;11:313-8. doi:10.1097/00000372-198908000-00004.
Paone JF, Baker RR. Pathogenesis and treatment of Paget's disease of the breast. Cancer. 1981;48:825-9. doi:10.1002/1097-0142(19810801)48:33.0.co;2-#.
Schelfhout VR, Coene ED, Delaey B, Thys S, Page DL, De Potter CR. Pathogenesis of Paget's disease: epidermal heregulin-alpha, motility factor, and the HER receptor family. J Natl Cancer Inst. 2000;92:622-8. doi:10.1093/jnci/92.8.622.
Cohen C, Guarner J, DeRose PB. Mammary Paget's disease and associated carcinoma. An immunohistochemical study. Arch Pathol Lab Med. 1993;117:291-4.
Osther PJ, Balslev E, Blichert-Toft M. Paget's disease of the nipple. A continuing enigma. Acta Chir Scand. 1990;156:343-52.
Kollmorgen DR, Varanasi JS, Edge SB, Carson WE 3rd. Paget's disease of the breast: a 33-year experience. J Am Coll Surg. 1998;187:171-7. doi:10.1016/s1072-7515(98)00143-4.
Song Y, Guerrero-Juarez CF, Chen Z, et al. The Msi1-mTOR pathway drives the pathogenesis of mammary and extramammary Paget's disease. Cell Res. 2020;30:854-72. doi:10.1038/s41422-020-0334-5.
Zheng S, Song QK, Zhao L, et al. Characteristics of mammary Paget's disease in China: a national-wide multicenter retrospective study during 1999-2008. Asian Pac J Cancer Prev. 2012;13:1887-93. doi:10.7314/apjcp.2012.13.5.1887.
Jamali FR, Ricci A, Deckers PJ. Paget’s disease of the nipple-areola complex. Surg Oncol Clin N. 1996;76:365-81. doi:10.1016/S0039-6109(05)70444-8.
Sakorafas GH, Blanchard K, Sarr MG, Farley DR. Paget's disease of the breast. Cancer Treat Rev. 2001;27:9-18. doi:10.1053/ctrv.2000.0203.
Hudson-Phillips S, Cox K, Patel P, Al Sarakbi W. Paget's disease of the breast: diagnosis and management. Br J Hosp Med (Lond). 2023;84:1-8. doi:10.12968/hmed.2022.0439.
Marshall JK, Griffith KA, Haffty BG, et al. Conservative management of Paget disease of the breast with radiotherapy: 10- and 15-year results. Cancer. 2003;97:2142-9. doi:10.1002/cncr.11337.
Chaudary MA, Millis RR, Lane EB, Miller NA. Paget's disease of the nipple: a ten year review including clinical, pathological, and immunohistochemical findings. Breast Cancer Res Treat. 1986;8:139-46. doi:10.1007/BF01807702.
Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget's disease of the nipple. Breast Cancer Res Treat. 2013;141:1-12. doi:10.1007/s10549-013-2661-4.
Nicoletti G, Scevola S, Ruggiero R, Coghi AM, Toussoun GS. Gigantic Paget disease of the breast. Breast. 2004;13:425-7. doi:10.1016/j.breast.2003.11.005.
Lopes Filho LL, Lopes IM, Lopes LR, Enokihara MM, Michalany AO, Matsunaga N. Mammary and extramammary Paget's disease. An Bras Dermatol. 2015;90:225-31. doi:10.1590/abd1806-4841.20153189.
Apalla Z, Errichetti E, Kyrgidis A, et al. Dermoscopic features of mammary Paget's disease: a retrospective case-control study by the International Dermoscopy Society. J Eur Acad Dermatol Venereol. 2019;33:1892-8. doi:10.1111/jdv.15732.
Liu J, Zhao Z, Zhou J, Zhang J. An unusual presentation of Paget's disease of the nipple in a young woman: a case report. Int J Clin Exp Med. 2015;8:4694-6.
Günhan-Bilgen I, Oktay A. Paget's disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases. Eur J Radiol. 2006;60:256-63. doi:10.1016/j.ejrad.2006.06.010.
Wong SM, Freedman RA, Sagara Y, Stamell EF, Desantis SD, Barry WT, Golshan M. The effect of Paget disease on axillary lymph node metastases and survival in invasive ductal carcinoma. Cancer. 2015;121:4333-40. doi:10.1002/cncr.29687.
Challa VR, Deshmane V. Challenges in diagnosis and management of Paget’s disease of the breast-a retrospective study. Indian J Surg. 2015;77:1083-7. doi:10.1007/s12262-014-1167-6.
Fu W, Mittel VK, Young SC. Paget disease of the breast: analysis of 41 patients. Am J Clin Oncol. 2001;24:397-400. doi:10.1097/00000421-200108000-00019.
Kothari AS, Beechey-Newman N, Hamed H, Fentiman IS, D'Arrigo C, Hanby AM, Ryder K. Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer. 2002;95:1-7. doi:10.1002/cncr.10638.
Sripathi S, Ayachit A, Kadavigere R, Kumar S, Eleti A, Sraj A. Spectrum of imaging findings in Paget’s disease of the breast-a pictorial review. Insights Imaging. 2015;6:419-29. doi:10.1007/s13244-015-0415-z.
Pelorca RJ, de Oliveira-Junior I, Vieira RA. Are there clinical and subclinical/pathological forms of Paget's disease of the breast? Front Oncol. 2023;13:1287882. doi:10.3389/fonc.2023.1287882.
Morrogh M, Morris EA, Liberman L, Van Zee K, Cody HS 3rd, King TA. MRI identifies otherwise occult disease in select patients with Paget disease of the nipple. J Am Coll Surg. 2008;206:316-21. doi:10.1016/j.jamcollsurg.2007.07.046.
Karamchandani DM, Chetlen AL, Riley MP, Schetter S, Hollenbeak CS, Mack J. Pathologic-radiologic correlation in evaluation of retroareolar margin in nipple-sparing mastectomy. Virchows Arch. 2015;466:279-87. doi:10.1007/s00428-014-1714-3.
Frei KA, Bonel HM, Pelte MF, Hylton NM, Kinkel K. Paget disease of the breast: findings at magnetic resonance imaging and histopathologic correlation. Invest Radiol. 2005;40:363-7. doi:10.1097/01.rli.0000163742.40401.4e.
Trebska-McGowan K, Terracina KP, Takabe K. Update on the surgical management of Paget's disease. Gland Surg. 2013;2:137-42. doi:10.3978/j.issn.2227-684X.2013.08.03.
Amano G, Yajima M, Moroboshi Y, Kuriya Y, Ohuchi N. MRI accurately depicts underlying DCIS in a patient with Paget's disease of the breast without palpable mass and mammography findings. Jpn J Clin Oncol. 2005;35:149-53. doi:10.1093/jjco/hyi044.
Gaurav A, Gupta V, Koul R, et al. Practical consensus recommendations for Paget's disease in breast cancer. South Asian J Cancer. 2018;7:83-6. doi:10.4103/sajc.sajc_107_18.
Rosen PP. Paget's disease of the nipple. In: Rosen's breast pathology. Philadelphia: Lippincott-Raven; 2001. p. 565-80.
Mariano L, Nicosia L, Pupo D, et al. A pictorial exploration of mammary Paget disease: insights and perspectives. Cancers (Basel). 2023;15:5276. doi:10.3390/cancers15215276.
Decaussin M, Laville M, Mathevet P, Frappart L. Paget's disease versus Toker cell hyperplasia in a supernumerary nipple. Virchows Arch. 1998;432:289-91. doi:10.1007/s004280050167.
Cai Y, Cheng Z, Nangong J, Zheng X, Yuan Z. Using immunohistochemistry to classify the molecular subtypes of Paget's disease of the breast. Cancer Med. 2023;12:14104-11. doi:10.1002/cam4.6068.
Morandi L, Pession A, Marucci GL, Foschini MP, Pruneri G, Viale G, Eusebi V. Intraepidermal cells of paget’s carcinoma of the breast can be genetically different from those of the underlying carcinoma. Hum Pathol. 2003;34:1321-30. doi:10.1016/s0046-8177(03)00405-2.
Arafah M, Arain SA, Raddaoui EM, Tulba A, Alkhawaja FH, Al Shedoukhy A. Molecular subtyping of mammary Paget's disease using immunohistochemistry. Saudi Med J. 2019;40:440-6. doi:10.15537/smj.2019.5.23967.
Liegl B, Leibl S, Gogg-Kamerer M, Tessaro B, Horn LC, Moinfar F. Mammary and extramammary Paget's disease: an immunohistochemical study of 83 cases. Histopathology. 2007;50:439-47. doi:10.1111/j.1365-2559.2007.02633.x.
Arain SA, Arafah M, Said Raddaoui EM, Tulba A, Alkhawaja FH, Al Shedoukhy A. Immunohistochemistry of mammary Paget's disease. Cytokeratin 7, GATA3, and HER2 are sensitive markers. Saudi Med J. 2020;41:232-7. doi:10.15537/smj.2020.3.24949.
Ozerdem U, McNiff JM, Tavassoli FA. Cytokeratin 7-negative mammary Paget's disease: a diagnostic pitfall. Pathol Res Pract. 2016;212:279-81. doi:10.1016/j.prp.2016.01.004.
Wachter DL, Wachter PW, Fasching PA, et al. Characterization of molecular subtypes of Paget disease of the breast using immunohistochemistry and in situ hybridization. Arch Pathol Lab Med. 2019;143:206-11. doi:10.5858/arpa.2017-0578-OA.
Lee SJ, Choe YS, Jung HD, et al. A multicenter study on extramammary Paget's disease in Korea. Int J Dermatol. 2011;50:508-15. doi:10.1111/j.1365-4632.2010.04661.x.
Aguayo-Carreras P, Bonilla-García L, Pérez-López I, Cuenca-Barrales C, Tercedor-Sánchez J. Paget’s disease of the breast: a dangerous imitator of eczema. Sultan Qaboos Univ Med J. 2017;17:487-8. doi:10.18295/squmj.2017.17.04.021.
Zengin HB, Tan PH, Liu R, Smoller BR. 'Eczematous' dermatitis of the nipple: clinical and histopathological differential diagnosis of Paget disease. Pathology. 2024;56:300-12. doi:10.1016/j.pathol.2023.10.018.
Cornia R, Cornia LO, Cornia Di, et al. Mammary Paget’s disease - a case presentation. DermatoVenerol (Buc.). 2020;65:47-52.
Bansal S, Sahoo B, Agarwal P, Garg VK, Rao S. A rare presentation of mammary Paget's disease involving the entire breast in the absence of any underlying ductal malignancy. Indian J Dermatol Venereol Leprol. 2013;79:518-21. doi:10.4103/0378-6323.113085.
Kanwar AJ, De D, Vaiphei K, Bhatia A, Sharma RK, Singh G. Extensive mammary Paget's disease. Clin Exp Dermatol. 2007;32:326-7. doi:10.1111/j.1365-2230.2006.02326.x.
Singla V, Virmani V, Nahar U, Singh G, Khandelwal NK. Paget's disease of breast masquerading as chronic benign eczema. Indian J Cancer. 2009;46:344-7. doi:10.4103/0019-509X.55560.
Alkul M, Lin CP, Truitt J, Tarbox MB. A tale of three common nipple diseases. Proc (Bayl Univ Med Cent). 2022;35:354-6. doi:10.1080/08998280.2022.2027195.
Song HS, Jung SE, Kim YC, Lee ES. Nipple eczema, an indicative manifestation of atopic dermatitis? A clinical, histological, and immunohistochemical study. Am J Dermatopathol. 2015;37:284-8. doi:10.1097/DAD.0000000000000195.
Waldman RA, Finch J, Grant-Kels JM, Whitaker-Worth D. Skin diseases of the breast and nipple: inflammatory and infectious diseases. J Am Acad Dermatol. 2019;80:1483-94. doi:10.1016/j.jaad.2018.08.067.
Peters MS, Lehman JS, Comfere NI. Dermatopathology of the female breast. Am J Dermatopathol. 2013;35:289-304; quiz 305-7. doi:10.1097/DAD.0b013e318267caa3.
Kim SK, Won YH, Kim SJ. Nipple eczema: a diagnostic challenge of allergic contact dermatitis. Ann Dermatol. 2014;26:413-4. doi:10.5021/ad.2014.26.3.413.
Sadovnikova A, Fine J, Tartar DM. Nipple thrush or dermatitis: a retrospective cohort study of nipple-areolar complex conditions and call for coordinated, multidisciplinary care. J Am Acad Dermatol. 2023;88:1383-4. doi:10.1016/j.jaad.2023.01.033.
Verma M, Waghmare S, Kachhawa D, Awake P, Sharma D. A clinico-epidemiological study of breast eczema sparing nipple and areola from a tertiary care hospital in western Rajasthan. Indian J Clin Exp Dermatol. 2023;9:194-8. doi:10.18231/j.ijced.2023.037.
Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA. 2020;323:1945-60. doi:10.1001/jama.2020.4006.
Saritas AG, Dalci K, Topal U, Beydola S, Acıkalın A, Rencuuzogullari A. Psoriasis, a rare disease of the nipple-areola: a case report. Ann Ital Chir. 2019;8:2239253X19031086.
Yang H, Brand JS, Li J, et al. Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study. BMC Med. 2017;15:154. doi:10.1186/s12916-017-0915-4.
Chau T, Parsi KK, Ogawa T, Kiuru M, Konia T, Li CS, Fung MA. Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis. J Cutan Pathol. 2017;44:1018-26. doi:10.1111/cup.13033.
Alessio C, Scali E, Manti F, et al. An unusual case of mammary Paget's disease in a woman with psoriasis. J Biol Regul Homeost Agents. 2016;30:589-92.
Di Tommaso L, Franchi G, Destro A, Broglia F, Minuti F, Rahal D, Roncalli M. Toker cells of the breast. Morphological and immunohistochemical characterization of 40 cases. Hum Pathol. 2008;39:1295-300. doi:10.1016/j.humpath.2008.01.018.
Ramos R, Campelos S, Fonseca-Moutinho J. Toker cell hyperplasia: a case report. Acta Obstet Ginecol Port. 2021;15:183-8.
van der Putte SC, Toonstra J, Hennipman A. Mammary Paget's disease confined to the areola and associated with multifocal Toker cell hyperplasia. Am J Dermatopathol. 1995;17:487-93. doi:10.1097/00000372-199510000-00010.
Liu X, Xu Y, Liu J, Sun S, Zhu Y, Lu H. Pathological and imaging features of Paget's disease and nipple adenoma: a comparative study. Gland Surg. 2022;11:207-15. doi:10.21037/gs-21-862.
Rodriguez PP, Crabtree M, Venegas R, Ozao-Choy J, Dauphine C. Nipple adenoma: a benign disease with a suspicious presentation. Am Surg. 2023;89:6243-5. doi:10.1177/00031348221117026.
Tsushimi T, Enoki T, Takemoto Y, Harada E, Hayashi M, Furuya T, Hamano K. Adenoma of the nipple, focusing on the contrast-enhanced magnetic resonance imaging findings: report of a case. Surg Today. 2011;41:1138-41. doi:10.1007/s00595-010-4381-2.
Dalal YD, Trivedi AK, Panchal V, Patel Y, Dalal DD. Nipple adenoma: case report of a rare entity. Cureus. 2022;14:22996. doi:10.7759/cureus.22996.
Da Costa D, Taddese A, Cure ML, Gerson D, Poppiti R Jr, Esserman LE. Common and unusual diseases of the nipple-areolar complex. Radiographics. 2007;27:65-77. doi:10.1148/rg.27si075512.
Spohn GP, Trotter SC, Tozbikian G, Povoski SP. Nipple adenoma in a female patient presenting with persistent erythema of the right nipple skin: case report, review of the literature, clinical implications, and relevancy to health care providers who evaluate and treat patients with dermatologic conditions of the breast skin. BMC Dermatol. 2016;16:4. doi:10.1186/s12895-016-0041-6.
Leo ME, Carter GJ, Waheed U, Berg WA. Nipple adenoma: Correlation of imaging findings and histopathology. J Breast Imaging. 2022;4:408-12. doi:10.1093/jbi/wbac019.
DI Bonito M, Cantile M, Collina F, D'Aiuto M, Liguori G, DE Cecio R, Botti G. Adenoma of the nipple: a clinicopathological report of 13 cases. Oncol Lett. 2014;7:1839-42. doi:10.3892/ol.2014.2000.
Ono S, Tanaka M, Yoshinaga Y, Satou T, Aoki M. A case of giant nipple adenoma. Surg Case Rep. 2024;10:70. doi:10.1186/s40792-024-01869-y.
Abbas A, Al-Zaher A, El Arini A, Chaudhry I. Adenoma of the nipple, mimicking Paget’s disease of the breast: report of a case. Adv Breast Cancer Res. 2014;3:96-9. doi:10.4236/abcr.2014.33014.
Gnangnon FH, Souaibou YI, Gbessi DG, Agbo TM, Dossou FM, Méhinto DK. Surgical management of erosive adenomatosis of the nipple: a case report. Int J Surg Case Rep. 2021;86:106234. doi:10.1016/j.ijscr.2021.106234.
Palaniappan V, Karthikeyan K. Bowen's disease. Indian Dermatol Online J. 2022;13:177-89. doi:10.4103/idoj.idoj_257_21.
Barrutia L, Martínez-García G, Santamarina-Albertos A, Garabito Solovera EL, Volo V, Ruíz-Sánchez D, Manchado López P. Differentiating pagetoid Bowen disease from Paget disease on the nipple-areola complex: two unique, challenging cases. J Cutan Pathol. 2021;48:1416-22. doi:10.1111/cup.14092.
Sofos SS, Tehrani H, Lymperopoulos N, Constantinides J, James MI. Primary squamous cell carcinoma of the nipple: a diagnosis of suspicion. J Plast Reconstr Aesthet Surg. 2013;66:315-7. doi:10.1016/j.bjps.2013.04.034.
Vohra P, Ljung BM, Miller TR, Hwang ES, van Zante A. Paget's disease of the breast masquerading as squamous cell carcinoma on cytology: a case report. Diagn Cytopathol. 2012;40:1015-8. doi:10.1002/dc.21712.
Chun KA, Cohen PR. Basal cell carcinoma of the nipple-areola complex: a comprehensive review of the world literature. Dermatol Ther (Heidelb). 2016;6:379-95. doi:10.1007/s13555-016-0128-3.
Takeno S, Kikuchi N, Miura T, et al. Basal cell carcinoma of the nipple in male patients with gastric cancer recurrence: report of a case. Breast Cancer. 2014;21:102-7. doi:10.1007/s12282-010-0217-6.
Sharma A, Tambat RM, Singh A, Bhaligi DS. Basal cell carcinoma of the nipple areola complex. J Midlife Health. 2011;2:89-90. doi:10.4103/0976-7800.92535.
Moennich J, Ort R, High W, Brown M. Breast carcinoma masquerading as basal cell carcinoma of the nipple. JAAD Case Rep. 2015;1:361-3. doi:10.1016/j.jdcr.2015.08.005.
Rao S, Wang A, Liu W, et al. Mammary Paget disease with melanocytic proliferation mimicking malignant melanoma in situ: a case report. Front Med (Lausanne). 2022;9:839954. doi:10.3389/fmed.2022.839954.
Nagata Y, Yoshioka M, Uramoto H, Tsurudome Y, Yamada S, Hanagiri T, Tanaka F. Malignant melanoma of the nipple: a case report. J Breast Cancer. 2018;21:96-101. doi:10.4048/jbc.2018.21.1.96.
Dehner CA, Johnson EF, Peters MS, Guo RR. Primary melanoma of the nipple: report of 10 cases including coexistence with Paget's disease. Pathol Res Pract. 2024;253:155058. doi:10.1016/j.prp.2023.155058.
Saitoh K, Saga K, Okazaki M, Maeda K. Pigmented primary carcinoma of the breast: a clinical mimic of malignant melanoma. Br J Dermatol. 1998;139:287-90. doi:10.1046/j.1365-2133.1998.02368.x.
Lee JH, Kim TH, Kim SC, Kim YC, Roh MR. Pigmented mammary Paget disease misdiagnosed as malignant melanoma. Ann Dermatol. 2014;26:747-50. doi:10.5021/ad.2014.26.6.747.
• Lin CW, Chiang MH, Tam KW. Treatment of mammary Paget disease: a systematic review and meta-analysis of real-world data. Int J Surg. 2022;107:106964. doi:10.1016/j.ijsu.2022.106964.
• Surgical guidelines for the management of breast cancer. Eur J Surg Oncol. 2009;35 Suppl 1:1-22. doi:10.1016/j.ejso.2009.01.008.
• Bijker N, Rutgers EJ, Duchateau L, Peterse JL, Julien JP, Cataliotti L. Breast-conserving therapy for Paget disease of the nipple: a prospective European Organization for Research and Treatment of Cancer study of 61 patients. Cancer. 2001;91:472-7. doi:10.1002/1097-0142(20010201)91:33.0.co;2-q.
• Rebielak M, Wolf M, Oxenberg J. Cutaneous squamous cell carcinoma of the nipple presenting as Paget’s disease. Am Surg. 2022;88:521-2. doi:10.1177/0003134820945233.
• Kawase K, Dimaio DJ, Tucker SL, et al. Paget's disease of the breast: there is a role for breast-conserving therapy. Ann Surg Oncol. 2005;12:391-7. doi:10.1245/ASO.2005.05.026.
• 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;107:1448-58. doi:10.1002/cncr.22137.
• Dalberg K, Hellborg H, Wärnberg F. Paget's disease of the nipple in a population based cohort. Breast Cancer Res Treat. 2008;111:313-9. doi:10.1007/s10549-007-9783-5.
• Li YJ, Huang XE, Zhou XD. Local breast cancer recurrence after mastectomy and breast-conserving surgery for Paget’s disease: a meta-analysis. Breast Care (Basel). 2014;9:431-4. doi:10.1159/000368431.
• Choudhury B, Bright-Thomas R. Paget's disease of the male breast with underlying ductal carcinoma in situ ('DCIS'). J Surg Case Rep. 2015;2015:037. doi:10.1093/jscr/rjv037.
• Dixon AR, Galea MH, Ellis IO, Elston CW, Blamey RW. Paget's disease of the nipple. Br J Surg. 1991;78:722-3. doi:10.1002/bjs.1800780627.
• Li C, Wang Y, Liu M, Qu J, Zhang S. Time for detailed clinical management of Paget's disease of the breast. Int J Surg. 2024;110:1266-7. doi:10.1097/JS9.0000000000000855.
• Polgár C, Orosz Z, Kovács T, Fodor J. Breast-conserving therapy for Paget disease of the nipple: a prospective European Organization for Research and Treatment of Cancer study of 61 patients. Cancer. 2002;94:1904-5. doi:10.1002/cncr.10405.
• Helme S, Harvey K, Agrawal A. Breast-conserving surgery in patients with Paget's disease. Br J Surg. 2015;102:1167-74. doi:10.1002/bjs.9863.
• Okonofua D, Soh CL, Tafazal H. An unusual case of complete pathological response to Paget's disease of the breast. J Surg Case Rep. 2022;2022:rjac106 . doi:10.1093/jscr/rjac106.
• Hu T, Chen Z, Hou M, Lin K. Overall and cancer-specific survival in patients with breast Paget disease: a population-based study. Exp Biol Med (Maywood). 2022;247:187-99. doi:10.1177/15353702211056264.
• Zhou H, Lu K, Zheng L, et al. Prognostic significance of mammary Paget's disease in Chinese women: a 10-year, population-based, matched cohort study. Onco Targets Ther. 2018;11:8319-26. doi:10.2147/OTT.S171710.
• Alshammari FO, Satari AO, Aljabali AS, et al. Glypican-3 differentiates intraductal carcinoma and Paget’s disease from other types of breast cancer. Medicina (Kaunas). 2022;59:86. doi:10.3390/medicina59010086.
• Hanyu T, Fujitani S, Ito A, Mizutani N. Brain metastasis from extramammary Paget's disease. Nagoya J Med Sci. 2020;82:791-8. doi:10.18999/nagjms.82.4.791.
• Sisti A, Huayllani MT, Restrepo DJ, et al. Paget disease of the breast: a national retrospective analysis of the US population. Breast Dis. 2020;39:119-26. doi:10.3233/BD-200439.
• Desai DC, Brennan EJ Jr, Carp NZ. Paget's disease of the male breast. Am Surg. 1996;62:1068-72.
World Health Organization. WHO classification of tumours of the breast. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. Geneva, Switzerland: World Health Organization; 2012.
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