Warning! What Looks Like Eczema or Psoriasis on the Breast Could Be Paget’s Disease – Breast Cancer

The rare breast cancer disease – Paget’s disease (Paget’s disease of the nipple or Mammary Paget’s disease) is often confused with the two common skin conditions eczema and psoriasis. All which are very similar, and which often force doctors to send their patients to specialists for correct diagnosis.

However, there are certain detectable differences between both Paget’s disease and other skin conditions that many women can look for when self-checking the breasts for cancer. Usually common skin conditions that affect the breasts are nothing to be worried about; however, with Paget’s disease, it is different.

1. Eczema – is a relatively common skin complain; although, it is considered a chronic inflammatory condition of the skin that consists of dry skin with red patches, together with an often itchy sensation that tends to provoke the condition to become worse when scratched (eczema rarely affects the nipple).

2. Psoriasis – is similar to eczema, but with patches of raised skin that are usually red in color, together with thick silvery scales (often considered a more hereditary disease [one in every two psoriasis cases is usually hereditary]) that appears on the skin (doctors are still unable to explain what causes it).

3. Paget’s disease – can affect both men and women (men in more extreme cases), and is considered a rather deadly form of cancer. Not only is the disease dangerous in itself, but 50% of women who suffer from it are also diagnosed with having one or more breast tumors (ductal carcinoma in-situ, or invasive breast cancer [stages I – III]) within the same breast where the disease is present.

Symptoms – are usually in the form of a red scaly rash that affects the nipple (an extension to the areola [the dark skin circle around the nipple] may often be present too) that may itch or burn. With Paget’s disease – malignant cells are usually present in the epidermis (the surface layer of skin) of both the areola, and the nipple (malignant cells may be found either singularly or formed in small groups).

Also an inverted nipple (pulled inwards) together with a nipple discharge are both common signs that a rash is more than just a common skin complaint. However, in comparison with the disease and more common skin complaints, it usually only affects one breast (most skin complains affect the two breasts).

The three main dangers of Paget’s disease are as follows:

1. Is because Paget’s disease is so similar to both eczema and psoriasis; it may well get mis-diagnosed.

2. It is because of the presence of malignant (cancerous) cells.

3. Around 50% of women sufferers may also be diagnosed with tumors of the breast.

Note: All three of these dangers may result in either a woman losing a breast, or becoming just another statistic of breast cancer fatality. Regular self-checks are seen prudent for early diagnosis of breast cancer. Any doubt (even minor) over anything unusual found: within, on, or around (the nipple area) the breast, being put to rest by an early consultation with either a doctor or health adviser.

Breast Cancer – Paget’s Disease

One of the rare types of Breast Cancer is Paget’s disease of the nipple, which can appear as a rash on the nipple. The rash or other changes in the nipple can indicate a cancer in the breast ducts, many times located under the nipple, which has then extended itself onto the surface of the nipple.

Sometimes this sign of breast cancer indicates a small ductal carcinoma in situ (DCIS), which is a very early breast cancer that has not yet left the duct. Other times, Paget’s disease of the nipple may indicate an invasive cancer somewhere else in the breast. In some cases, a woman who shows signs of Paget’s disease of the nipple will additionally have an abnormal mammogram or have lump in her breast.

Before we move on I want to clarify that Paget’s disease of the nipple is not the same as Paget’s disease of the bone, which is a severe bone disease. Sir James Paget, a British surgeon and physiologist, discovered both conditions which were first documented by him, but they are completely unrelated diseases. Paget’s disease of the nipple can also affect men, although it is rare.

Paget’s disease of the nipple is often first noticed when physical signs of the disease appear. Signs of Paget’s disease usually only occur on one nipple and can include persistent crustiness, scaliness, or redness of the nipple, itching or burning of the nipple and surrounding areola and bleeding or oozing from the nipple and areola.

Paget’s disease can often be confused with other skin conditions, such as breast eczema. Breast Eczema is a highly treatable condition which can be characterized by red, itchy patches or weeping blisters around the nipple which reoccur, but clear up with proper treatment. Paget’s disease does not clear up with routine treatment for eczema or infection and usually only affects one nipple.

A mammogram is the next step to check for cancer in the actual breast. Sometimes any underlying abnormal breast mass will not be present on a mammogram. A clean mammogram combined with an abnormal nipple finding requires further investigation.

A biopsy of the nipple tissue will need to be performed. Usually this consists of a “punch biopsy” that removes a small amount of tissue to check for cancer. If the mammogram indicates other areas of concern within the breast, biopsies of those areas should be performed.

If Paget’s disease is caught early while it is still confined to the nipple and underlying breast ducts, the patient typically has an excellent prognosis. However, if Paget’s disease of the nipple is associated with an invasive breast cancer or if the cancer has spread out of the breast to other areas of the body (metastatic disease), the survival rate can be lower.

Treatment of Paget’s disease of the nipple involves surgery, radiation treatment and Chemotherapy or drug therapy (such as tamoxifen). Like other types of breast cancer, the location of the cancer will determine which type of surgery is done – a lumpectomy or mastectomy. Radiation therapy usually follows a lumpectomy.

A recent development in surgical treatment involves removing only the nipple and areola (sometimes followed by radiation therapy) in patients whose Paget’s disease has no other underlying breast cancer, thus allowing the woman to keep her breast. Following treatment, an artificial nipple can be recreated using skin grafts and tattooing.