Breast Paget Disease: A Rare Cancer in Dermatology

Paget's disease (PD) of the breast is a rare disease of the nipple-areola complex often associated with underlying carcinoma, accounting for less than 4% of all breast carcinomas. We report a case of Paget's disease remarkable for its rarity, the diagnostic delay and the relatively young age of our patient in the Dermatology department of the Donka National Hospital. A 38-year-old woman consulted for itching of the left nipple associated with an oozing erythematous-squamous plaque and tumor-like left axillary lymphadenopathy evolving since4 years. Clinical examination and histopathology confirmed breast Paget's disease. A left mastectomy with lymph node dissection was performed, supplemented by chemotherapy. The evolution was good with absence of recurrence and metastasis after a follow-up of 16 months. Paget's disease corresponds to the invasion of the nipple epidermis by ductal carcinoma in situ (CIS), a rare variant of CIS. Classically, it develops between the ages of 51 and 70, however cases of Paget's disease of the nipple in young women during periods of genital activity have been reported in the literature as illustrated by our observation. The diagnosis of PD is often made late. An easy biopsy should be offered for all unilateral eczematous lesions of the nipple to compensate for this diagnostic delay. Mastectomy or breast-conserving surgery is often recommended. Adjuvant treatments are discussed on a case-by-case basis.