What are Paget's disease of the nipple and inflammatory breast cancer?

Paget's disease of the nipple is an eczema-like, scaly/ulcerated change of the nipple-areola caused by malignant cells in the epidermis - it indicates an underlying breast cancer (DCIS or invasive) and must not be mistaken for eczema.

Inflammatory breast cancer is an aggressive cancer presenting with a red, warm, swollen, oedematous (peau d'orange) breast, mimicking mastitis but not responding to antibiotics.

Clinical relevance. Recognising Paget's (persistent nipple change) and inflammatory cancer (non-resolving 'mastitis') prevents missing aggressive breast cancers.

More Detail

Paget's disease and inflammatory breast cancer

Two presentations of breast cancer that can be mistaken for benign conditions.

Paget's disease of the nipple

• An eczema-like change of the nipple/areola - scaling, redness, itching, ulceration, or discharge, caused by malignant (Paget) cells in the epidermis.
• Indicates an underlying breast cancer (usually DCIS, sometimes invasive).
• Key point: it affects the nipple first (unlike eczema which usually starts on the areola), and persistent nipple changes need biopsy - do not mistake for eczema.

Inflammatory breast cancer

• An aggressive cancer presenting with a red, warm, swollen, tender, oedematous breast with peau d'orange (from dermal lymphatic invasion).
• Mimics mastitis but does not respond to antibiotics and there is often no discrete lump.
• Needs urgent assessment/biopsy; treated with neoadjuvant chemotherapy then surgery and radiotherapy.

Message

• Persistent nipple eczema or a 'mastitis' not resolving on antibiotics (especially in a non-lactating woman) should prompt cancer exclusion.