Paget's Disease of the Breast: Signs and Symptoms
When It’s Not Just Skin Deep:
Understanding Paget’s Disease
A Rare Breast Cancer That Too Often Gets Missed
“Paget’s Disease of the Breast: Misdiagnosed, Misunderstood—and Often Missed”
Survivor Voices and Surgical Wisdom from Dr. Yara Robertson,
Medical Advisor for Learn Look Locate
What begins as a red, itchy, or flaking nipple is often dismissed as eczema or an infection – when in reality, it’s a rare form of breast cancer called Paget’s disease of the breast. And while time is lost, the cancer can spread.
At Learn Look Locate, we’re shedding light on this overlooked diagnosis by bringing together the stories of real survivors—Laura, Judi, Zandra, and Alisha—who were told it was “just a skin issue” until it wasn’t. Alongside them, Dr. Yara Robertson, Breast Surgical Oncologist and trusted Medical Advisor to Learn Look Locate, offers her expert clinical guidance to help patients and providers recognize the signs and take action. With the insights from our team of 20 Medical Advisors, we’re dedicated to unraveling the complexities of this disease.
This page is a collaboration between survivors and a leading expert in breast surgery—built to empower women with accurate information, shared experience, and the tools to advocate for themselves. Because every misdiagnosis delayed is a diagnosis denied.
“Paget’s disease doesn’t always show up on a mammogram. That’s why awareness of the skin changes and patient advocacy are critical. When we listen to survivors and take every symptom seriously, we can save lives.”
— Dr. Yara Robertson, Breast Surgical Oncologist and Medical Advisor, Learn Look Locate
Hi, I’m Laura—
I was told I had two kinds of breast cancer: DCIS, which many people know about, and Paget’s disease of the breast, which hardly anyone talks about. It took two years to get that diagnosis.
Two years of being dismissed. Of being told it was just a rash. Of constantly wondering why it wouldn’t go away. What I really want to say is this: if something feels wrong—keep pushing. I did. And it saved my life
Diagnosed with Paget’s at 34
Hi, I’m Alisha from Australia-
At 27, I was a healthy, fit mum of six when I found a lump in my breast. I was told it was a staph infection, and over the next 18 months I saw more than 25 doctors—including six GPs, two breast specialists, and countless midwives—begging someone to help.
My nipple was cracked, oozing, and bleeding, but no one looked beyond infection. While pregnant with my seventh baby, I kept pushing. At 29 weeks pregnant, I was finally diagnosed with stage 3 HER2+ breast cancer. That nipple? It was Paget’s disease all along.
Diagnosed with Paget’s at 29
Hi, I’m Zandra!
After two years of symptoms, I was diagnosed with a rare form of breast cancer called Paget’s disease. Paget’s disease of the breast accounts for approximately 1% of all breast cancers.
— Zandra, diagnosed with Paget’s at 36
Hi I’m Judi!
I had Paget’s disease of the nipple with a secondary tumor-invasive ductal cell carcinoma behind the nipple. I insisted on a biopsy. All I kept hearing was use this cream. I had a mammogram the prior month and it showed nothing. I knew something was off, it was cracked and itched. Once side only. So I insisted on a biopsy which came back as both of these diagnoses..
-Judi, diagnosed at 50
Listening to Your Body, Empowering Your Health
A persistent change on your nipple or the skin around it—maybe some redness, flaking, or itching that just won’t clear up—demands your gentle attention. While it might feel like familiar eczema, it’s truly crucial to understand that this could be Paget’s disease of the breast, a rare form of breast cancer often mistaken for common skin conditions. This can, unfortunately, lead to critical delays in diagnosis.
We deeply believe that when you’re truly informed, you feel empowered to face anything. As Dr. Yara Robertson wisely says, “The best patient is an informed patient.” Our heartfelt mission is to shed light on this often-misunderstood disease and to walk alongside you. We do this by sharing real stories of strength and hope from survivors, alongside insights from our compassionate medical experts. We’re here to gently give you the knowledge and resources you need to confidently advocate for your own well-being.
As Dr. Yara Robertson, a warm and trusted Breast Surgical Oncologist and Medical Advisor, reminds us: “Paget’s disease doesn’t always show up on a mammogram. That’s why awareness of the skin changes and patient advocacy are critical. When we listen to survivors and take every symptom seriously, we can save lives.” This guide is crafted with immense care, designed to be your warm and trusted companion as you bravely navigate your path forward. And remember, as you embark on this journey, “Take a deep breath, it’s going to be okay.”
“It took two years to get that diagnosis. Two years of being dismissed, of being told it was just a rash. Of constantly wondering why it wouldn’t go away.” We hear your fears, and we want you to know you’re not alone.
Laura
Understanding Paget's Disease:
What You Need to Know
What Exactly is Paget's Disease of the Breast?
Paget’s disease of the breast is a rare cancer that often begins gently on the skin of your nipple and can then spread to the darker area around it, called the areola. It’s important to remember this is distinct from Paget’s disease of the bone, which is a different condition entirely.
This type of cancer is uncommon, accounting for about 1% to 4% of all breast cancer cases. What makes it unique is that the cancer cells usually start deep inside your milk ducts and then journey to the surface of your nipple and areola. This means the visible skin changes you see are often a sign of a deeper breast cancer, though very rarely, it might be confined just to the nipple skin. Because it’s rare and can look so much like a simple skin rash, it can sometimes be missed, making your awareness and persistence incredibly valuable.
While it’s most common in women over 50, Paget’s disease can also gently affect younger women and, in very rare instances, men. Knowing the symptoms and risk factors is key for everyone to catch it early.
Recognizing the Symptoms:
Your Body's Gentle Whispers
The early signs of Paget’s disease can be subtle and easily confused with everyday skin issues. It’s so incredibly important to pay close attention to any persistent or unusual changes in your nipple or areola.
Here are the common symptoms to watch for:
- Redness or scaling of the nipple skin. Please keep in mind that this redness might be harder to see on black or brown skin tones.
- Itching or tingling sensations in the nipple or areola.
- Crusting or flaking of the nipple, which can look a lot like eczema.
- Yellowish or bloody nipple discharge.
- A flattened or inverted nipple, meaning it looks different from its usual shape.
- A lump that you can feel in your breast or directly behind the nipple.
A very important clue that can help tell Paget’s disease apart from other conditions is that its symptoms typically affect only one breast. Also, these symptoms might come and go, or even seem to get better temporarily with creams. This can be misleading, making you think it’s healing when it’s not. If these symptoms persist, even if they fluctuate or seem to respond briefly to treatments, it’s a significant warning sign that needs a specialized medical check-up.
“Two years before being diagnosed, I began experiencing a burning sensation in my breasts, and one of my nipples became inverted and started to look flat. I also noticed a white discharge from the nipple that resembled dried breast milk. I had no lumps or masses.”
Zandra
“I was given topical steroids and antibiotics. But nothing worked. It kept coming back. Eventually, the oozing got so bad I had to keep my nipple covered all the time. I just knew—this wasn’t normal.”
Laura
“As weeks went on, I was back and forth to doctors; the lump was growing, and antibiotics were not helping. My nipple had become a white tip with a chunk missing, constantly bleeding and oozing.”
Alisha
“All I kept hearing was use this cream, I knew someting was off-it was cracked and itched, one side only, I insisted on a biopsy.”
Judi
Key Differences: Paget’s
Disease vs. Eczema Dermatitis
Affected Area (Initial)
Nipple first, then spreads to the areola
Areola first, then spreads to nipple or other chest areas
Affected Breast (s)
Usually one breast
Often affects both breasts
Appearance
Redness, scaling, crusting, flaking, oozing thickening
Dry, discolored, itchy, bumpy, rough sensitive, cracked skin
Sensations
Itching, burning, tingling
Intense itching , tingling, burning
Nipple Changes
Flattened, inverted, yellowish or bloody discharge, lump
Rough/sensitive nipples, nipple fractures
Response to Topical Treatments (e.g., steroid creams)
May temporarily improve but symptoms persist or recur; doesn’t fully resolve
Often symptoms persist or recur; doesn’t fully resolve Often resolves with appropriate creams or by avoiding triggers
Persistence
Persistent changes, even if they come and go
May resolve with treatment or trigger avoidance
The Challenge of Misdiagnosis:
Why Your Voice Matters
Paget’s disease is often mistaken for common, harmless skin conditions like eczema, leading to initial treatments that might offer temporary relief, but accidentally hide the true issue. This brief improvement can give a false sense of security, further delaying an accurate diagnosis. Early detection and prompt treatment are truly vital for significantly improving your outcomes
“Paget’s disease of the breast is so easy to miss. It looks like eczema. It acts like a rash. It doesn’t show up on regular mammograms or ultrasounds. But it’s almost always connected to another cancer underneath—just like mine.” Your experience and intuition about your body are powerful.
-Laura
Your Path to Diagnosis:
What to Expect and How to Advocate
When to See a Healthcare Professional: Don't Wait, Advocate!
If you’re experiencing persistent changes in your nipple or areola—like redness, flaking, or itching—that don’t go away with typical treatments, it’s essential to see a healthcare professional right away. Your first stop should usually be your General Practitioner (GP), Primary Care Physician (PCP), or Gynecologist. If they gently suspect breast cancer, or if your symptoms continue despite initial treatments for benign conditions, they will guide you to a specialist breast clinic for further evaluation. Please remember, getting a referral to a breast clinic doesn’t automatically mean you have cancer; it simply means a closer, more accurate look is needed to figure out what’s causing your symptoms
“If something feels wrong, keep pushing. I did. And it saved my life.”
Laura
“I insisted on a biopsy, I feel you have to be an advocate, you can’t let anyone dismiss you. Had I listened would I be here?”
Judi
What type of doctor should I see if I notice unusual nipple or areola changes?
Should I see a dermatologist for nipple irritation or skin changes?
Many people with Paget’s disease are first referred to a dermatologist, especially if symptoms appear to be skin-related. However, dermatologists may not always recognize that these signs could be linked to an underlying breast cancer. If treatment from a dermatologist doesn’t resolve your symptoms, don’t wait. Follow up with a primary care doctor or gynecologist and request a referral to a breast specialist. Early imaging and biopsy are essential when symptoms persist. Laura’s story shows how advocating for yourself can make all the difference.
Essential Questions to Ask Your Doctor at Your Initial Visit
Preparing for your doctor's appointment can help you feel more in control
and ensure all your concerns are addressed. Consider asking the following
questions; they are your voice in the room:
Question
Why it Matters
“Given my persistent nipple/areola changes, could this possibly be Paget’s disease of the breast?”
Directly addresses the core concern and potential misdiagnosis, gently prompting your doctor to consider this rare but serious condition.
“What is your diagnostic plan if these symptoms do not improve with initial treatments?”
Sets clear expectations for next steps and prevents prolonged ineffective treatments, giving you peace of mind.
“Should I be referred to a breast specialist or breast clinic for further evaluation?”
Specialists have the expertise and equipment for definitive testing, ensuring you get the right care.
“What specific diagnostic tests (mammogram, ultrasound, MRI, biopsy) do you recommend, and why?
Encourages a comprehensive diagnostic approach and helps you understand the rationale behind each test, so you’re never left wondering.
“How can I best document my symptoms to help with diagnosis?”
Shows your commitment to providing thorough information and can lead to valuable advice on symptom journaling, making your story clear.
“What are the potential benefits and risks of each recommended test?”
Ensures you provide informed consent and understand the implications of each procedure, empowering your decisions.
“What are the next steps if initial imaging tests are inconclusive?”
Prepares you for the possibility of needing a biopsy, which is the definitive diagnostic tool for Paget’s, so you know what’s next.
Diagnostic Procedures: A Closer Look
Once Paget’s disease is suspected, a series of diagnostic procedures will typically be undertaken to confirm the diagnosis and check for any underlying breast cancer.
Clinical Examination: Your compassionate healthcare provider will perform a thorough
physical examination of your breasts and the surrounding lymph nodes, including those
in your armpit and above your collarbone. This visual and manual check helps identify
any lumps, skin changes, or other abnormalities.
Imaging Tests
Mammography
- This is an X-ray of the breast, mainly used to find underlying tumors or tiny calcium deposits (micro calcifications). While it’s a standard screening tool for breast cancer, its ability to specifically diagnose Paget’s disease is limited. Paget’s disease primarily affects the skin of the nipple and areola, and these surface changes might not show up clearly on a mammogram. Mammograms are only about 50% effective at detecting Paget’s disease, and as Dr. Robertson points out, ”Paget’s disease doesn’t always show up on a mammogram” This low effectiveness is a big reason for diagnostic delays and misdiagnosis. You must understand that a “clear; mammogram does not definitively rule out Paget’s disease. This knowledge empowers you to understand why a negative mammogram shouldn’t be the end of your diagnostic journey and why you must advocate for further, more definitive testing if your symptoms continue.
- Your Experience: During a mammogram, your breast will be gently compressed between two plates. This compression is necessary for clear images and might cause some discomfort or even pain, but it’s usually brief. It’s important to tell the technologist if you feel intense pain, so they can adjust.
- Preparation: You’ll need to remove all clothing and jewelry from the waist up. It’;s best to avoid using deodorant, antiperspirant, lotion, or body powder on your breasts or underarms on the day of the exam, as these products can interfere with the X-ray images.
Ultrasound
- This imaging technique uses high-frequency sound waves to create detailed pictures of your breast tissue, without any radiation. It’s especially useful for looking at anything unusual found on a mammogram, determining if a lump is a fluid-filled cyst or a solid tumor, and for examining breast tissue in people with dense breasts or those who are pregnant or breastfeeding.
- Your Experience: A clear, warm gel will be applied to your breast, and a handheld device called a transducer will be moved over the area being examined. This procedure is generally comfortable and non-invasive, a gentle peek inside.
- Preparation: Similar to mammography, it’s best to avoid applying lotions or powders to your breasts on the day of the exam.
MRI (Magnetic Resonance Imaging)
- Your Experience: You’ll typically lie face down on a padded table that slides into the MRI machine. The machine makes loud banging noises during the scan, and you’ll be given earplugs to help. An intravenous (IV) line might be placed in your arm for a contrast dye injection, which helps highlight certain tissues. It’s important to tell the staff if you feel claustrophobic, as sedatives might be available to help you relax and feel more comfortable.
- Preparation: You must tell your healthcare team if you are pregnant or breastfeeding, have any allergies to contrast dye, or have any metal implants or objects in your body. You may need to lie still on your stomach for 30 to 60 minutes during the procedure.
Should I expect the doctor to do a biopsy—or should I push for one?
- Yes, you should absolutely expect—and if needed, advocate—for a biopsy if Paget’s disease is suspected or if symptoms like nipple irritation or skin changes persist despite normal imaging. A biopsy is the only way to confirm a diagnosis of Paget’s disease and to check for any underlying breast cancer. Trust your instincts, and don’t be afraid to speak up if something doesn’t feel right.
Can the biopsy be done in a doctor’s office?
- It depends on the type of biopsy needed. Skin biopsies of the nipple or areola are often done in a doctor’s office using local anesthetic. However, if your doctor suspects there might be an underlying breast mass, you may need a more advanced breast biopsy, typically performed in a breast clinic or outpatient imaging center with specialized equipment. Your care team will guide you based on your symptoms and imaging results.
Navigating Treatment Options:
A Personalized Approach
Treatment Overview: Tailored to Your Specific Needs
Your treatment plan for Paget’s disease of the breast will be highly personalized, based on your specific diagnosis and overall health. The approach depends significantly on whether there is any underlying breast cancer, such as:
- DCIS (Ductal Carcinoma In Situ) – a non-invasive breast cancer where abnormal cells are found in the lining of the milk ducts but haven’t spread.
- Invasive breast cancer – when cancer cells have spread beyond the ducts into surrounding breast tissue.
Your medical team will also consider the stage of the cancer and important biological markers like hormone receptor status (estrogen or progesterone receptor-positive) and HER2 status, all of which help determine the most effective treatment.
Laura’s diagnosis was carefully tailored to her specific needs:
“My pathology came back ER-, PR-, HER2+, with high-grade DCIS.”
Your care will be gently managed by a dedicated multidisciplinary team of specialists. This team
typically includes a breast surgeon, a medical oncologist (who specializes in cancer treatment
with medication), and a radiation oncologist (who specializes in radiation therapy). These
experts work together to create a coordinated, personalized treatment plan that addresses all
aspects of your diagnosis. This comprehensive, team-based approach ensures that all potential
treatment avenues are considered, optimizing your chances of successful outcomes and providing a holistic view of your care.
Alisha’s Story: Pregnancy and Persistent Symptoms: Fighting for a Diagnosis:
A year had passed, and I was prepping for a bodybuilding comp. I fell pregnant with our miracle baby.
I stopped antibiotics as I didn’t want to harm the baby, and after a year, they had not had any effect on my growing lump. After six doctors, two breast specialists, multiple midwives, and doctors at my antenatal appointments, I would beg anyone and everyone for assistance so I could get my breasts healthy to feed my baby once he arrived. I must have visited doctors between 25-30 times, feeling like a hypochondriac. I finally had a doctor who said.
”Maybe this is something other than a cyst”
and after 18 months since first found my lump. I had a biopsy the next
day, and at 29 weeks pregnant, I was diagnosed with stage 3 BC. I had a mastectomy at 33
weeks. I had 7 out of 16 lymph nodes affected with cancer; they ranged from 1-3cm each in
size, and the mass in my breast was 9.5cm. I was HER2+, and the cracked, oozing nipple that
was my first indication something was wrong turned out to be Paget’s disease of the nipple. I
then had to deliver our son at 36 weeks. I was due to start chemo when he was 20 days old. But
first, after his birth, I had to have a CT scan and bone scan that I was not able to have while
pregnant.”
Surgical Options
Surgery is often the main treatment for Paget’s disease of the breast to remove the cancerous tissue.
Mastectomy:
Removal of the entire breast, including the nipple and areola. Often recommended for larger tumors or multiple cancer areas.
This was the brave path Laura chose:“On March 1, 2017, I had a radical mastectomy with one lymph node removed “and a tissue expander placed.”
Breast-Conserving Surgery (Lumpectomy/ Central Excision):
Aims to preserves asmuch of the breast as possible by removing the nipple, areola, and cancerous lump witha small margin of healthy tissue. This is almost always followed by radiation therapy. For localized disease, it can offer similar outcomes to mastectomy.
Lymph Node Assessment:
A sentinel node biopsy gently checks if cancer has spread to the first few lymph nodes. If clear, no more nodes are usually removed. If cancer is ound, an axillary lymph node dissection (removal of more nodes) may be recommended. Laura had one lymph node removed, and thankfully, it was clear.
Alisha’s experience highlighted the extent of spread: “I had 7 out of 16 lymph nodes affected with cancer; they ranged from 1-3cm each in size.”
Breast Reconstruction:
After surgery, you can choose to restore breast shape using implants or your own body tissue. This can be done immediately or later. Nipple reconstruction, including realistic medical tattooing, is also an option. Laura underwent a complex reconstruction process:
“In July 2017, I had my first reconstruction surgery. I had a tissue expander swap, a capsulectomy, and MENTOR® MemoryGel® implants placed…Then, in October 2017, I had fat grafting using liposuction from my stomach. Because I had no fat or skin left, they had to use AlloDerm during my earlier reconstruction just to support the implant. This last step helped smooth out the areas that felt hollow and unfinished.”
Additional Therapies
Beyond surgery, other therapies may be recommended to gently target remaining cancer cells and reduce recurrence risk.
Radiation Therapy:
- Uses high-energy X-rays to destroy microscopic cancer cells after especially after breast-conserving surgery.
- Common Side Effects: Fatigue, skin irritation (like a sunburn), breast swelling.
Hormone Therapy:
- For hormone receptor-positive cancers, it lowers hormone levels or blocks their effects.
- Common Side Effects: Hot flashes, night sweats, vaginal dryness, joint/muscle pain.
Immunotherapy:
- Boosts your body’s immune system to bravely fight cancer cells. Currently approved for high-risk early-stage and metastatic triple-negative breast cancer.
- Common Side Effects: Diarrhea, fatigue, skin rash, thyroid issues.
Navigating a diagnosis of Paget’s disease of the breast can feel overwhelming and isolating. However, it’s crucial to remember that you are not alone, and there are many resources and strategies available to bravely empower you throughout your journey.
Becoming Your Own Advocate: Essential Steps
Educate Yourself About Your Diagnosis:
Speak Up About Your Symptoms:
Document Your Journey:
- Keep a Symptoms Journal: Note dates, times, descriptive words for how symptoms feel, location, frequency, and severity. Include anything that triggers or affects your symptoms, and how they impact your daily life.
- Notes for Appointments: Write down all your questions before each visit. Take notes on discussions, diagnoses, and next steps.
- Bring a Loved One to Appointments: Having a trusted friend or family member with you is incredibly helpful. They can listen, take notes, help remember details, and offer emotional support.
- Ask Follow-Up Questions: If anything is unclear, ask for clarification during or after your visit. There are no “stupid questions” when it comes to your health.
- Seek a Second Opinion: You have every right to seek a second opinion especially for a serious diagnosis or if you’re considering experimental treatments. It can confirm your plan or offer new perspectives. Laura bravely pursued this: “I decided to refer myself to the Brown Cancer Center in Louisville, KY.”
- Consider Clinical Trials: Clinical trials explore promising new treatments. Participating can offer access to cutting-edge therapies not yet widely available
Learn Look Locate:
At Learn Look Locate (LLL), we are dedicated to empowering awareness and advocacy for Paget’s disease of the breast. Our website is a patient-friendly hub, offering comprehensive educational resources, including guides on breast cancer awareness, prevention, and the latest advancements in treatment options. We feature inspiring stories of resilience and hope from breast cancer survivors globally, aiming to uplift and connect you with vital support networks. You’ll also find discussions with our 20 medical experts to enhance your understanding and decision-making.
Imerman Angels Partnership: One-on-One Support:
Imerman Angels Partnership: One-on-One Support: Learn Look Locate is closely aligned with Imerman Angels, an incredible resource that provides one-on-one support for patients and caregivers. Whether you need a mentor who has walked a similar path or wish to become one to support others, Imerman Angels connects you with someone who truly understands. This personalized peer support can make a profound difference in your journey. Find your mentor at Immerman Angels.
Is Paget’s disease of the breast always associated with underlying cancer?
In most cases, yes. It’s often linked to ductal carcinoma in situ (DCIS) or invasive breast cancer. Rarely, it may occur without an underlying tumor.
Can men develop Paget’s disease of the breast?
Yes, though very rare, men can develop it. Symptoms are similar to women and require prompt medical evaluation.
What is the prognosis for Paget’s disease of the breast?
The outlook varies depending on the underlying cancer and its stage. Early detection and treatment significantly improve outcomes, with high chances for a cure when caught early.
Do symptoms come and go?
Yes, a key and often misleading aspect of Paget’s disease is that its symptoms might come and go, or even appear to improve temporarily with creams. This fluctuation can lead to delays in diagnosis, making you think the issue is resolving when it’s not. If you experience persistent, recurring symptoms, even if they seem to fluctuate, it’s crucial to seek specialized medical attention.
What kind of specialist should I see?
Your initial consultation should be with your General Practitioner (GP), Primary Care Physician (PCP), or Gynecologist. If Paget’s disease or breast cancer is suspected, or if your symptoms persist, they will likely refer you to a breast specialist or a breast surgical oncologist. These specialists have the most in-depth knowledge and tools for diagnosing and treating breast conditions, including rare ones like Paget’s disease.
Should I see a dermatologist?
While Paget’s disease often mimics skin conditions like eczema, and some individuals like Laura initially see a dermatologist, it’s important to be aware that a dermatologist might not immediately consider or be equipped to diagnose the underlying breast cancer. If you consult a dermatologist for nipple or areola symptoms and they don’t fully resolve with treatment, it is vital to also see your GP or gynecologist and advocate for a referral to a breast specialist.
Should I expect the doctor to do a biopsy or should I push for it? Can it be done simply in the office?
If Paget’s disease is suspected based on your examination or imaging, a biopsy is the only definitive way to confirm the diagnosis. You should absolutely expect and advocate for a biopsy, especially if your symptoms persist despite “clear” imaging results. While a skin biopsy from the nipple or areola can often be performed simply in the office with local anesthetic, breast biopsies for underlying masses may require imaging guidance (like ultrasound, mammography, or MRI) and are typically done in a breast clinic or outpatient setting.
What are the first signs of Paget’s disease of the breast?
The most common early signs include redness, itching, flaking, or crusting of the nipple or areola, often resembling eczema. Some people notice nipple inversion, discharge, or burning sensations. These symptoms can come and go or affect only one side. If you notice changes that don’t go away with topical creams, it’s important to seek further evaluation, as these may signal Paget’s disease.
Is Paget’s disease of the breast the same as eczema?
No, but it often looks like eczema on the surface. That’s what makes Paget’s disease tricky to diagnose. It causes scaly, itchy, or red skin on the nipple, similar to common skin conditions. However, unlike eczema, Paget’s disease is linked to an underlying breast cancer in over 85% of cases. If you’ve been treated for eczema and the symptoms don’t improve, push for a biopsy and breast imaging.
How is Paget’s disease of the breast diagnosed?
Diagnosis typically involves a skin biopsy of the nipple or areola, often done in the office. Your doctor may also order a mammogram, breast ultrasound, or MRI to check for an underlying tumor, such as ductal carcinoma in situ (DCIS) or invasive breast cancer. A biopsy is the only way to confirm the diagnosis, so don’t hesitate to ask for one if your symptoms persist.
Do I need a biopsy if my nipple symptoms won’t go away?
Yes. If you’ve been treated for conditions like eczema or mastitis and your symptoms don’t improve, a biopsy is essential. This is the only way to confirm or rule out Paget’s disease and detect any hidden breast cancer. Even if imaging is clear, biopsy gives you answers at the cellular level—and peace of mind.
Can a dermatologist diagnose Paget’s disease?
A dermatologist can identify suspicious skin changes, but may not always connect them to breast cancer. Paget’s disease is often misdiagnosed as a skin condition, especially in its early stages. If symptoms like nipple irritation, flaking, or redness don’t go away with treatment, follow up with your primary doctor or gynecologist, and request a referral to a breast specialist for further imaging and biopsy.
Is Paget’s disease of the breast the same as Paget’s disease of bone?
No, they are two completely different conditions. Paget’s disease of the breast is a rare form of breast cancer that affects the nipple and areola, often linked to an underlying tumor like DCIS or invasive breast cancer. In contrast, Paget’s disease of bone is a chronic bone disorder that causes bones to grow abnormally and become weak or misshapen. The only thing they share is the name, which comes from Sir James Paget, the doctor who first described both conditions. Always specify “of the breast” when searching or asking questions to avoid confusion.
About the Expert
Expert Insight from Dr. Yara Robertson,
Breast Surgical Oncologist
Medical Advisor, Learn Look Locate
Dr. Yara V. Robertson, MD, FACS, is a nationally respected breast surgical oncologist and the Medical Director of Surgical Oncology at CARTI Cancer Center. With over 15 years of experience and a deep commitment to equitable, patient-centered care, Dr. Robertson has been a trusted voice in breast cancer education and a dedicated Medical Advisor to Learn Look Locate since the very beginning.
As both a skilled surgeon and a kidney cancer survivor herself, Dr. Robertson brings unmatched empathy and warmth to her work—qualities that shine through in every conversation she has with patients. Her belief that “the best patient is an informed patient” is at the heart of what we do at Learn Look Locate: helping individuals feel more confident, comforted, and empowered on their journey.
Dr. Robertson’s expertise has been especially meaningful in bringing greater awareness to Paget’s disease of the breast—a rare and often misdiagnosed form of breast cancer. Her compassionate insight helps patients and providers alike recognize the early signs and advocate for timely, accurate care.
She is also the medical advisor behind our male breast cancer initiative, playing a vital role in breaking the silence around this often-overlooked diagnosis. Although rare, male breast cancer can and does happen—and thanks to Dr. Robertson’s leadership, we are proud to feature courageous male survivors and provide education that speaks directly to men and their families.
Her voice is featured throughout some of our most powerful educational content, including our comprehensive Breast Cancer Surgery Guide, our Paget’s Disease Awareness page, our survivor-led video series, and the dedicated Male Breast Cancer page—ensuring no one feels alone, unheard, or unseen in their diagnosis.
Medically reviewed and created in collaboration with Dr. Yara V. Robertson, MD, FACS, Breast Surgical Oncologist and Medical Advisor for Learn Look Locate.
From Cynthia Jordan, Founder of Learn Look Locate:
“I am beyond grateful for Dr. Robertson’s time, dedication, and compassionate guidance—especially when it comes to educating about Paget’s disease of the breast. Her steady voice and heartfelt commitment help bring comfort, clarity, and connection to those navigating a diagnosis they may never have expected.”
Understanding Paget’s Disease of the Breast
Inflammatory breast cancer is rare and can progress quickly. These resources can help you better understand your diagnosis and next steps.
This content has been medically reviewed by:
Yara Robertson, MD, FACS
Breast Surgical Oncologist and Medical Advisor for Learn Look Locate
