Multimodal Imaging Detection of Difficult Mammary Paget Disease: Dermoscopy, Reflectance Confocal Microscopy, and Line-Field Confocal–Optical Coherence Tomography

Mammary Paget disease (MPD) is a rare cutaneous malignancy associated with underlying ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC). Clinically, it appears as eczematous changes in the nipple and areola complex (NAC), which may include itching, redness, crusting, and ulceration;...

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Published in:Diagnostics (Basel) Vol. 15; no. 15; p. 1898
Main Authors: Cantisani, Carmen, Caruso, Gianluca, Taliano, Alberto, Longo, Caterina, Rizzuto, Giuseppe, D’Andrea, Vito, Pietkiewicz, Pawel, Bortone, Giulio, Gargano, Luca, Suppa, Mariano, Pellacani, Giovanni
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 29.07.2025
MDPI
Subjects:
Architecture
Biopsy
Breast cancer
Carcinoma, Ductal
Consent
Cysts
dermoscopy
Diagnostic imaging
Diseases
Interesting Images
Italy
line-field optical-coherence tomography
Lymphatic system
mammary Paget disease
Melanoma
Microscope and microscopy
Microscopy
nipple areola complex
reflectance confocal microscopy
Skin
Tomography
Italy
reflectance confocal microscopy
nipple areola complex
line-field optical-coherence tomography
mammary Paget disease
dermoscopy
ISSN:2075-4418, 2075-4418
Online Access:Get full text
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Summary:Mammary Paget disease (MPD) is a rare cutaneous malignancy associated with underlying ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC). Clinically, it appears as eczematous changes in the nipple and areola complex (NAC), which may include itching, redness, crusting, and ulceration; these symptoms can sometimes mimic benign dermatologic conditions such as nipple eczema, making early diagnosis challenging. A 56-year-old woman presented with persistent erythema and scaling of the left nipple, which did not respond to conventional dermatologic treatments: a high degree of suspicion prompted further investigation. Reflectance confocal microscopy (RCM) revealed atypical, enlarged epidermal cells with irregular boundaries, while line-field confocal–optical coherence tomography (LC-OCT) demonstrated thickening of the epidermis, hypo-reflective vacuous spaces and abnormally large round cells (Paget cells). These non-invasive imaging findings were consistent with an aggressive case of Paget disease despite the absence of clear mammographic evidence of underlying carcinoma: in fact, several biopsies were needed, and at the end, massive surgery was necessary. Non-invasive imaging techniques, such as dermoscopy, RCM, and LC-OCT, offer a valuable diagnostic tool in detecting Paget disease, especially in early stages and atypical forms.
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ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics15151898