A family member was recently diagnosed with Paget's carcinoma of the breast. It was found in the nipple. It started with a dry scab on the nipple in 1994 and never showed up on sonogram or mammogram. The treatment for the scab was different creams. Whenever the scab would peel off there would be a small amount of bleeding. Everyone thought it was psoriasis. A dermatologist made the diagnosis even before taking a biopsy, and surgery is scheduled to see if it has spread. What is this kind of cancer, and how is it best treated?

--Caidu

Paget's disease of the nipple is an uncommon type of breast cancer; it accounts for only 0.7-4.3 percent of all breast cancers. Most of the women with Paget's are in their 50s or 60s. It arises from the ducts around the nipple and appears as a thin, reddened area that often itches or burns. Half of all patients with Paget's will have a mass under the nipple, but mammography is not useful in detecting Paget's disease per se.

With early lesions, in which there is no large underlying mass and that have not spread throughout the ductal system of the breast, it may be enough to remove the nipple, areola and underlying breast tissue. If disease is more advanced, a mastectomy is usually recommended. A surgeon specializing in the treatment of breast cancer is the best resource for discussing treatment options. The National Institutes of Health cancer line may also be helpful (1-800-4-CANCER, or 1-800-422-6237).