Pigmented mammary Paget's disease mimicking melanoma: report of three cases

• Published in: EJD. European journal of dermatology Vol. 22; no. 1; pp. 121 - 124
• Main Authors: HIDA, Tokimasa, YONETA, Akihiro, NISHIZAKA, Takahiro, OHMURA, Tousei, SUZUKI, Yasuyo, KAMESHIMA, Hidekazu, YAMASHITA, Toshiharu
• Format: Journal Article
• Language: English
• Published: Montrouge John Libbey Eurotext 2012
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Dermatology; Dermoscopy; Diagnosis, Differential; Diseases of the osteoarticular system; Female; Humans; Mastectomy; Medical sciences; Melanoma - diagnosis; Melanoma - pathology; Osteoporosis. Osteomalacia. Paget disease; Paget's Disease, Mammary - diagnosis; Paget's Disease, Mammary - pathology; Paget's Disease, Mammary - surgery; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; Tumors of the skin and soft tissue. Premalignant lesions; Mammilla; Dermatology; nipple; Paget disease; melanoma; Malignant tumor; Malignant melanoma; Pigments; Breast; pigmented mammary Paget's disease; Mammary gland; Cancer; dermoscopy
• ISSN: 1167-1122; 1952-4013
• DOI: 10.1684/ejd.2011.1580

Pigmented mammary Paget's disease (PMPD) is a rare subtype of mammary Paget's disease. The differential diagnosis of PMPD and melanoma is difficult clinically and sometimes histopathologically. Here we present three cases of PMPD with a variable-sized lesion. All cases showed an irregular-shaped black-brown macule, one of which was accompanied by nipple retraction. Dermoscopically, all cases showed reticular pigmentation with or without irregular black dots, regression structures and streaks, which were indistinguishable from those of melanoma. In all but one of the cases, preoperative examinations confirmed the presence of a subcutaneous mammary lesion. All patients underwent a total mastectomy with the histopathological results indicating invasive ductal carcinoma. These cases emphasize how difficult it is to distinguish PMPD from melanoma. Dermoscopic features also mimic those of melanoma, but the reticular pigmentation seen in all cases could be a feature specific to PMPD. For suspicious cases, histopathological assessment using immunohistochemistry is highly recommended.