Nipple and areola lesions: review of dermoscopy and reflectance confocal microscopy features

Abstract

The differential diagnosis of nipple and areola complex (NAC) lesions encompasses a large spectrum of conditions from benign tumours to inflammatory diseases that could be challenging to recognize on clinical ground. While melanoma (MM) of the NAC is exceedingly rare, benign lesions are more frequent but could be difficult to distinguish from MM.Besides MM, other malignant tumours can affect this area and in particular Paget's disease (PD). For clinically doubtful lesions, biopsy is required, with possible functional and aesthetic consequences in this sensitive area. Dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of many skin lesions, but their use for NAC lesions is not well established. The objective of this study was to evaluate current literature on these imaging techniques for NAC lesions. We searched in Medline, PubMed and Cochrane database all studies up to November 2018 dealing with dermoscopy, RCM and this special site. We found that the most described malignant tumour was PD and that only three primary MMs of the NAC have been reported with these imaging techniques. Although there are few data on diagnostic accuracy of non-invasive imaging techniques for NAC lesions, it seems that dermoscopy and RCM can add relevant information to be integrated with clinical examination for the diagnosis of NAC lesions and in particular for the differential diagnosis of PD and eczema.

Identifying the cause of breast and nipple pain during lactation

“…An uncommon type of breast cancer that appears similar to eczema on the breast or nipple 19. Occurs infrequently…”

Evaluation of in vivo reflectance confocal microscopy in the diagnosis of extramammary Paget's disease

“…The characteristic features of eczema under RCM include cavernous degeneration, exocytosis, vesicle formation, and vasodilation (Astner, González, & Gonzalez, 2006). It was found that PD could be differentiated from eczema by the presence of dark Paget cells, which refer to PD, and the fact that spongiosis was more frequently found in eczema than in PD (Cinotti et al, 2019). In detail, eczema showed a regular honeycomb with blurred focus and multiple dark areas with clear border and fulfilled bright reflective particles.…”

Co-existence of hyperkeratosis of the nipple and supernumerary nipple in a young woman: Clinical and dermoscopic characteristics

“…surface, pink homogeneous surface, scales, red dots and small erosions. 8 It should be placed in the differential diagnoses of lesions which exhibit hyperkeratotic crusts along with arborizing vessels on dermoscopy.…”