Pigmented mammary Paget disease mimicking cutaneous malignant melanoma

Brugués, Albert; Iranzo, Pilar; Díaz, Alba; Peña, Adriana; Estrach, M.T.; Carrera, Cristina

doi:10.1016/j.jaad.2015.01.015

Cited by 12 publications

(16 citation statements)

References 2 publications

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“…Two primary MMs, two nevi, PDs, melanoses, two BCCs, two nevoid hyperkeratosis, three adenomas/erosive adenomatosis of the nipple one eczema and five vemurafenib‐induced hyperkeratosis have been described in case reports. Most descriptions only concern dermoscopy, and only eight cases have been evaluated with RCM . Moreover, a large multicentric study evaluated 131 NAC lesions at clinical, dermoscopic and RCM examination and compared the diagnostic accuracy of these three examinations .…”

Section: Resultsmentioning

confidence: 99%

“…In the literature, there are 34 dermoscopic descriptions of PD of the NAC and they are heterogeneous. Nineteen showed a grey‐blue pigmentation, an atypical vascular pattern, regression structures, pink‐whitish areas, nine an atypical pigmented network, eight irregular dots/globules, five irregular streaks, three scaling and one a blue‐white veil . Linear vessels were often found, whereas dotted vessels were reported in only four cases .…”

Section: Resultsmentioning

confidence: 99%

“…Paget's disease could also mimic MM . In the multicentric study, two out of four pigmented PDs were diagnosed as MM by the 7‐point checklist dermoscopic score, but none of them by the RCM Pellacani's score .…”

Section: Resultsmentioning

confidence: 99%

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

Cinotti

Galluccio

Tognetti

et al. 2019

Acad Dermatol Venereol

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Cinotti

Galluccio

Tognetti

et al. 2019

Acad Dermatol Venereol

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“…On clinical grounds, MPD displays an unspecific morphologic pattern, usually manifesting as an ulcerated, crusted or scaly patch or plaque on the nipple that may extend to the areolar region . The clinical recognition of MPD is challenging, since it may closely simulate a variety of benign and malignant skin conditions . Early diagnosis is crucial to initiate detailed work‐up for the detection and management of the very probable underlying breast malignancy.…”

Section: Introductionmentioning

confidence: 99%

Dermoscopic features of mammary Paget’s disease: a retrospective case‐control study by the International Dermoscopy Society

Apalla

Errichetti

Kyrgidis

et al. 2019

Acad Dermatol Venereol

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Background Mammary Paget's disease (MPD) is a rare intraepidermal adenocarcinoma of the nipple-areola complex, associated with an underlying breast cancer in approximately 90% of cases. Delayed diagnosis of MPD is common. Its dermoscopic features have been ill defined in the literature. ObjectivesTo determine the clinical and dermoscopic features of MPD versus other dermatologic entities that involve nipple and areola.Methods Members of the IDS were invited to submit any case of histologically confirmed MPD, as well as other benign and malignant dermatoses that involve the nipple and areola complex. A standardized evaluation of the dermoscopic images was performed and the results were statistically analyzed.Results Sixty-five lesions were included in the study, 22 (33.8%) of them MPD and 43 (66.2%) controls. The most frequent dermoscopic criteria of MPD were white scales (86.4%) and pink structureless areas (81.8%), followed by dotted vessels (72.7%), erosion/ulceration (68.2%) and white shiny lines (63.6%). The multivariate analysis showed that white scales and pink structureless areas were significant predictors of MPD, posing a 68-fold and a 31-fold probability of MPD, respectively. Split of the population into pigmented and non-pigmented lesions showed that in pigmented MPD, pink structureless areas, white lines and grey granules and dots are positive predictors of the disease. Among nonpigmented lesions, pink structureless areas, white lines, erosion/ulceration and white scales served as predictors of MPD. Conclusions The most frequent profile of an individual with MPD is an elderly female with unilateral, asymptomatic, erythematous plaque of the nipple, dermoscopically displaying pink structureless areas, fine white scales, dotted and a few short linear vessels. In case of pigmentation we may also observe brown structureless areas and pigmented granules.Limitations Small sample size, retrospective design.

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“…Regarding MPD, most of the attention has been focused on the pigmented variant, with diffuse irregular pigmentation, regression-like structures (especially gray-blue structures) and irregular vessels being described as the commonest findings by several reports45. According to a recent instance, some of the above-mentioned features may be found even in the classic (clinically nonpigmented) form of MPD, including light brown diffuse pigmentation, irregular black dots, irregularly distributed blue-gray dots (peppering), and irregular linear vessels; moreover, several chrysalis-like structures may additionally be detected1.…”

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confidence: 99%

Dermoscopy as a Supportive Instrument in the Early Recognition of Erosive Adenomatosis of the Nipple and Mammary Paget's Disease

et al. 2017

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Pigmented mammary Paget disease mimicking cutaneous malignant melanoma

Cited by 12 publications

References 2 publications

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

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

Dermoscopic features of mammary Paget’s disease: a retrospective case‐control study by the International Dermoscopy Society

Dermoscopy as a Supportive Instrument in the Early Recognition of Erosive Adenomatosis of the Nipple and Mammary Paget's Disease

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