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Dermoscopy of paget's disease

1 Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India

Date of Web Publication23-Jan-2020

Correspondence Address:
Yasmeen J Bhat,
Department of Dermatology, STD and Leprosy, Government Medical College, Srinagar, Karan Nagar Srinagar, Jammu and Kashmir - 190 010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_64_19

How to cite this URL:
Bhat YJ, Bashir S, Wani R, Hassan I. Dermoscopy of paget's disease. Indian Dermatol Online J [Epub ahead of print] [cited 2021 Nov 27]. Available from: https://www.idoj.in/preprintarticle.asp?id=276592

A 45-years-old female presented with a longstanding itchy lesion on the left breast for last eight months. Patient complained of severe itching and burning sensation in the lesion. On examination, a well-defined, erythematous to hyperpigmented, indurated, scaly and crusted plaque was seen over the left nipple and surrounding areola [Figure 1]. No palpable mass was found on examination of the breasts, and no regional lymphadenopathy was noted. Dermoscopy of the central erythematous portion revealed whitish pink area with irregular dotted vessels and chrysalis like structures. Multiple dotted vessels surrounded by white halos and adherent fabric fibers in structureless dark red areas were seen [Figure 2] and [Figure 3]a, [Figure 3]b. A skin biopsy was obtained from the lesion and sent for histopathological examination which demonstrated features consistent with mammary Paget's disease [Figure 4]a and [Figure 4]b.
Figure 1:A well-defined, erythematous to hyperpigmented, indurated, scaly and crusted eczematous plaque on the left breast

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Figure 2: Dermoscopic image showing whitish pink area with irregular dotted vessels (yellow arrow) in the central portion. White roundish globules (blue arrow) and Adherent fabric fibers (black arrow) are seen. Surrounding area shows dark brown diffuse pigmentation with irregular blue grey dots (green arrow) (Nonpolarized mode, Dermlite DL3N, California USA, 10X)

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Figure 3: (a): Irregular linear vessels (yellow), chrysalis-like structures (blue), multiple dotted vessels surrounded by white halos on a bluish background (green arrow) Adherent fabric fibers are seen in structureless dark red areas (black arrow) (Polarized mode, Dermlite DL3N, California USA, 10X). (b): Diffuse pigmentation with irregular blue grey dots (green arrow) (Polarized mode, Dermlite DL3N, California USA, 10X)

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Figure 4: (a): Photomicrograph showing large pale staining cells infiltrating the epidermis (blue arrow). (H and E 100X) (b): Photomicrograph showing tumor cells with abundant eosinophilic cytoplasm and large vesicular nucleus with prominent nucleolus (blue arrows). (H and E 400×)

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Paget's disease (PD) of the breast was first described by Sir James Paget in 1874 in 15 women with chronic eczematous disease on the skin of the nipple and the areola.[1] It is a very rare entity and comprises 1-4% of all patients with breast cancer.[2] The peak incidence of mammary Paget's disease is between 50 and 60 years, and it occurs almost exclusively in females, being extremely rare in males. It is now widely accepted that mammary Paget's disease is always associated with an underlying carcinoma of the breast even in the absence of lump or mammographic abnormality.[3]

Dermoscopy of the lesion reveals irregular linear vessels and multiple blue grey dots (peppering) corresponding to melanophages in the papillary dermis. Shiny white streaks or chrysalis like structures were recently identified as dermoscopic features of mammary Paget's disease.[4] They are oriented parallel or orthogonally to each other and represent new or remodelled collagen bundles. Chrysalis like structures have been described in other conditions like dermatofibroma, scars, basal cell carcinoma, pyogenic granuloma, spitz nevus and melanoma. The pigmented variant displays a non-specific pattern with diffuse irregular pigmentation and regression like structures.[5] The pigmented variant on dermoscopy needs to be differentiated from melanoma. Dermoscopy can thus be a useful tool in the early diagnosis of mammary Paget's disease which may otherwise be missed, especially in the absence of any associated breast lump or lymphadenopathy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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   References Top

Paget J. On disease of the mammary areola preceding cancer of the mammary gland. St Bartholomew's Hosp Rep 1874;10:87-9.  Back to cited text no. 1
Valdes EK, Feldman SM. Paget's disease of the breast. Breast J 2006;12:83.  Back to cited text no. 2
Chaudary MA, Millis RR, Lane EB, Miller NA. Paget's disease of the nipple: A ten year review including clinical, pathological, and immunohistochemical findings. Breast Cancer Res Treat 1986;8:139-46.  Back to cited text no. 3
De Crignis GS, de Abreu L, Bucard AM, Barcaui CB. Polarised dermoscopic of mammary Paget's disease. An Bras Dermatol 2013;88:290-2.  Back to cited text no. 4
Longo C, Fantini F, Cesinaro AM, Bassoli S, Seidenari S, Pellacani G. Pigmented mammary paget disease: Dermoscopic,in vivo reflectance-mode confocal microscopic, and immunohistochemical study of a case. Arch Dermatol 2007;143:752-4.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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