Paget disease of the breast typically presents with which findings?

• A. Lump in the breast without skin changes
• B. Nipple inversion without skin rash
• C. Chronic eczematous itchy, scaling rash on the nipples & areola
• D. Chronic eczematous itchy, scaling rash on the nipples and areola; a lump is often present

Answer: (D)

Paget disease of the breast involves malignancy affecting the nipple-areolar complex and classically presents with a chronic eczematous, itchy, scaling rash of the nipple and areola. This rash is often crusty and red and may be accompanied by underlying breast cancer, so a lump is frequently present beneath the affected area. The combination of a persistent nipple-areolar rash with a lump reflects the typical clinical picture, making this option the best description. A lump alone lacks the characteristic skin changes; a nipple inversion without a rash omits the hallmark skin involvement; a rash without any lump is less typical since Paget disease is commonly associated with an underlying tumor. If persistent nipple-areolar eczema is observed, evaluate for Paget disease and underlying cancer.