51-Year-Old Woman Treated For Persistent Nipple Skin Scaling Problem; Further Tests Reveal Early Breast Cancer
Thane : For a 51-year-old woman, what initially appeared to be a stubborn skin condition over the nipple turned out to be an early sign of breast cancer.
The woman had been experiencing persistent scaling and crusting around the breast for nearly three months. Despite undergoing multiple local treatments for the ‘eczematoid’ symptoms, there was no significant improvement.
The persistence of the problem prompted her to seek a specialist opinion at KIMS Hospitals, Thane, where she was evaluated by Dr. Vani Parmar, Head of Department of Breast Oncosurgery, KIMS Hospitals, Thane.
A detailed clinical examination raised suspicion that the problem may not be limited to the skin. A mammogram was subsequently performed and showed a segmental distribution of fine, pleomorphic microcalcifications extending from the central breast towards the axillary region.
The imaging findings raised suspicion of an extensive ductal lesion, with ductal carcinoma in situ (DCIS) being considered the likely possibility. However, an invasive cancer could not initially be completely ruled out.
A biopsy was therefore performed to establish the diagnosis.
The biopsy confirmed Paget’s disease of the breast, associated with underlying ductal carcinoma in situ (DCIS).
Paget’s disease is an uncommon form of breast cancer that affects the skin of the nipple and surrounding area. Its symptoms can sometimes resemble common eczema-like skin conditions, with scaling, crusting, redness or irritation, which can make the condition difficult to recognise initially.
In this case, further investigation helped identify the underlying disease while it was still at a non-invasive stage.
The patient underwent breast-conserving surgery with partial breast reconstruction. As the affected area was completely involved, the nipple also had to be removed, followed by reconstruction.
The final pathology report showed that the entire lesion remained ductal carcinoma in situ (DCIS), with no evidence of invasive cancer.
Further receptor testing showed that the cancer was hormone-sensitive. Based on the final pathology and receptor profile, the patient’s treatment plan included radiotherapy and hormonal treatment, without chemotherapy This meant she could undergo breast-conserving treatment rather than a mastectomy, while also avoiding chemotherapy and its associated side effects.
Explaining the case Dr. Vani Parmar said, “Persistent skin changes of the nipple or areola in the breast that do not improve with appropriate treatment should not simply be assumed to be eczema or another routine skin condition. While many such symptoms have benign causes, persistence is a reason to investigate further. In this patient, additional evaluation helped us identify an underlying cancer at an early, non-invasive stage.”
She added, “The important message is not to panic about every skin change, but to pay attention when something persists despite treatment. Early assessment can help establish the cause and, when cancer is detected, may allow treatment to be planned before the disease becomes invasive.”
Doctors advise women not to ignore persistent changes involving the breast, particularly symptoms such as scaling, crusting, redness, ulceration or unusual discharge that do not settle with treatment. A new lump, change in breast shape or persistent unexplained discomfort should also be medically evaluated by a breast surgeon.
The case highlights how a symptom that may initially appear minor can sometimes point to an underlying condition requiring specialist assessment. In this case, seeking an early expert opinion after the symptoms failed to improve helped uncover the disease at an early curative stage and enabled her to preserve her breast and undergo a curative treatment.
