Lésion érosive du mamelon

Paget’s disease of the breast was first described by Sir James Paget in 1874. Although rare, it is often associated with underlying carcinoma in situ or invasive cancer. It accounts for 1-3 % of mammary tumors and less than 5% of breast cancers in humans. We report the case of a 50 year-old patient presenting with left erosive lesion of the nipple evolving over more than 1 year. Clinical examination showed oozing erosive lesion measuring 1,5 cm in diameter at the level of the areola of the left breast with crusts on the periphery and inverted nipple (A). There was no adenopathy or palpable mass. Many diagnoses have been mentioned: chronic eczema, Paget’s disease or even erosive adenomatosis of the nipple. A skin biopsy was performed objectifying Paget’s disease associated with invasive ductal carcinoma. Mammography and ultrasound results fell into BIRADS 1. Thoraco-abdominopelvic CT scan and bone scintigraphy were normal. The patient underwent mastectomy with lymph node dissection. The histology objectified Paget’s disease with invasive ductal carcinoma and the lymph nodes were free. The patient underwent chemotherapy and radiation therapy with good evolution at two years follow-up.