Pigmented mammary Paget's disease

Pigmented spots as a sign of mammary Paget’s disease

“…We diagnosed the patient as having mammary Paget’s disease with pigmented spots on the right nipple. Together with a recent case of PMPD with a small blackish macule, 3 our case suggests the need to perform a skin biopsy of the pigmented spots on the nipple of elderly people.…”

“…Fontana–Masson stain indicated that the pigmented spots were caused by increased numbers melanin granules in the basal keratinocytes, the cytoplasm and dendritic processes of melanocytes and the cytoplasm of the Paget cells. Previously, hyperpigmentation in PMPD has been shown to be associated with increased melanin granules in basal keratinocytes, 4 melanocytes, 2–6 Paget cells 3,6 and/or dermal melanophages 5 …”

“…The histopathological findings in our case showed that the rounded cells formed small nests on the suprabasal layers of the epidermis. In malignant melanoma in situ , single melanoma cells or nested cells are present at all levels throughout the epidermis 3 . Using an immunohistochemical technique, the rounded cells stained negatively for S100, HMB‐45, and Melan‐A, which commonly show positive staining in melanoma cells.…”

“…Pigmented mammary Paget’s disease (PMPD) is an uncommon variant of mammary Paget’s disease 1–6 . Histopathological examination is required because the clinical and dermoscopical appearance mimics malignant melanoma 2–6 . We present a case in which pigmented spots were a sign of mammary Paget’s disease.…”

Pigmented mammary Paget’s disease: not a melanoma

“…Pigmented MPD is a rare clinicopathological variant 4–18 of Paget’s disease of the nipple. The diagnosis of this variant is difficult clinically, even with advanced non‐invasive diagnostic techniques such as dermoscopy and in vivo reflectance‐mode confocal microscopy, 11 which have been demonstrated to improve diagnostic accuracy in dermatological oncology 11,19–27 .…”