10.5826/dpc.1301a40
text/xml
2160-9381
2508
en
Adriana Rendon
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Dermoscopic Features of Pigmented Mammary Paget Disease
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-01-31
2022-04-04
2023-01-31
2023-03-01
e2023040
Dermatol Pract Concept
Adriana Rendon
2023/01/31
10.5826/dpc.1301a40
e2023040
Dermatology Department, Heidelberg University Clinic, Heidelberg, Germany 
2160-9381
en
e2023040
Apalla Z, Errichetti E, Kyrgidis A, Stolz W, Puig S, Malvehy J et al. Dermoscopic features of mammary Paget’s disease: a retrospective case‐control study by the International Dermoscopy Society. Journal of the European Academy of Dermatology and Venereology 2019; 33: 1892–1898.
Dermoscopic Features of Pigmented Mammary Paget Disease
https://dpcj.org/index.php/dpc/article/download/2508/1971
                     Dermoscopic Features of Pigmented
                         Mammary Paget Disease
                                      Arturo Robles-Tenorio1, Adriana Rendon2


1 School of Medicine and Health Sciences, Tecnologico de Monterrey, Nuevo Leon, Mexico
2 Dermatology Department, Heidelberg University Clinic, Heidelberg, Germany



Citation: Robles-Tenorio A, Rendon A. Dermoscopic Features of Pigmented Mammary Paget Disease. Dermatol Pract Concept.
2023;13(1):e2023040. DOI: https://doi.org/10.5826/dpc.1301a40
Accepted: May 11, 2022; Published: January 2023
Copyright: ©2023 Robles-Tenorio et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Adriana Rendon, Dermatology Department, Heidelberg University Clinic, Im Neuenheimer Feld 440,
Heidelberg, Germany 69120, +49 06221-5634296, E-mail: adriana.rendon@med.uni-heidelberg.de




Case Presentation                                                        Teaching Point
A 69-year-old, Hispanic woman presented with a 6-month                   Pigmented mammary Paget disease (PMPD) is a rare pre-
history of an irregular, asymmetrical, dark brown lesion on the          sentation of a breast intraductal carcinoma that extends
left nipple, surrounded by a discrete pink plaque (Figure 1A).           to the epidermis of the nipple-areola complex [1]. The
Dermoscopic examination showed an atypical pigment net-                  main differential diagnoses include malignant melanoma
work, black granules and globules at the center of the lesion,           and pigmented epidermotropic metastases of breast car-
as well as structureless pink and white areas (Figure 1B).               cinoma. PMPD dermoscopy findings include atypical
Histopathology revealed epidermal infiltration by large,                 pigment network, structureless blue-grey areas, brown or
atypical, pale cells. Immunohistochemistry was negative for              blue dots and globules, as well as other non-pigmented
negative for s100, Melan-A, and HMB-45, hence ruling out                 findings (structureless pink and/or white areas) [2]. His-
the presumptive diagnosis of malignant melanoma. Immu-                   topathology and immunohistochemistry are essential for
nohistochemical staining for CK7 and GATA3 was positive                  the diagnosis. Particularly in skin of color patients, further
and therefore, pigmented mammary Paget disease was di-                   dermoscopic descriptions are warranted, as even benign
agnosed. The patient was referred to the surgical oncology               lesions (lentigo, nipple-areola melanosis, naevi, seborrheic
team and underwent modified radical mastectomy. No evi-                  keratosis) can resemble PMPD. Therefore, new-onset,
dence of lymph node invasion was detected. At the 6-month                evolving, pigmented lesions in the nipple-areola complex
follow up, the patient remains free of recurrence.                       should be biopsied.




Image Letter | Dermatol Pract Concept. 2023;13(1):e2023040                                                                               1
Figure 1. Pigmented mammary Paget disease. (A) Clinical inspection revealed a heterogeneously pigmented, irregular lesion affecting the left
nipple, surrounded by a discrete pink plaque. (B) Dermoscopy findings included an atypical pigment network admixed with structureless pink
and white areas, as well as black granules/globules towards the center of the lesion.




References                                                               2. Apalla Z, Errichetti E, Kyrgidis A, et al. Dermoscopic features
                                                                            of mammary Paget’s disease: a retrospective case‐control study
 1. Requena L, Sangueza M, Sangueza OP, Kutzner H. Pigmented                by the International Dermoscopy Society. J Eur Acad Derma-
    mammary Paget disease and pigmented epidermotropic metastases           tol Venereol. 2019;33(10):1892-1898. DOI: 10.1111/jdv.15732.
    from breast carcinoma. Am J Dermatopathol. 2002;24(3):189-198.          PMID: 31270878.
    DOI: 10.1097/00000372-200206000-00001. PMID: 12140433.




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