Pagetʹs disease of the nipple and breast cancer: problems with diagnosis

32 patients with clinical and biopsy proven Pagetʹs disease of the nipple were treated over a 25-year period at three Bristol hospitals. Four additional cases which had Pagetʹs change found histologically are included. 16 patients had a palpable mass in addition to nipple changes. Definitive treatment included; a modified radical mastectomy (18), simple mastectomy (11), wedge excision (4) wide local excision and radiotherapy (2) and tamoxifen alone (1). An associated invasive palpable tumour proved the most significant prognostic factor being present in 7 of 8 patients demonstrating recurrence within 5 years. Mammography revealed a high false negative rate (8 of 17) but was the single positive investigation in one patient. Scrape smear cytology of the nipple skin eruption was positive in the 6 cases examined and may be the preferred choice of diagnostic technique.