This is a very rare form the breast cancer and it starts on the nipple of the breast as the name suggests, then it may spread to the surrounding area of the nipple called the areola ( dark circle of skin around the nipple). It usually affects older women (age >50) and is known to accompany DCIS and also sometime invasive breast cancer. It is an invasive disease in nature and is rarely confined to the nipple of the breast at its originating site. It should not be confused with Paget's disease of the bone which is a metabolic bone disease. Because this condition affects the nipple it is many a times confused with skin disorders like dermatitis and other benign skin ailments.
This disease is characterized by textured, scaly/ flaky nipple skin, nipple discharge, hardening of nipple which may appear crusty, itching and reddening of skin with burning feeling. The nipple may become inverted or flattened. Also there may be a lump in the breast in advanced stages. These abnormalities may be seen initially in one breast. as the symptoms are typical of a skin ailment the symptoms may go way with a topical treatment and the women may tend to ignore a breast cancer evaluation leading to delayed diagnosis.
Clinical breast exam and physical exam. During this exam, your doctor physically checks for unusual areas in both breasts, noting the appearance of the skin on and around your nipples and feeling for any lumps or areas of thickening. The step by step diagnosis process involves a basic initial physical examination of the breasts for detecting any lumps or firm tissue in the breast. This is followed by imaging tests. First a mammogram is done to visibly detect the accumulation of cancerous cells. And also to detect tuomor growths in the surrounding tissue. Ultra sound imaging or an MRI is also done for the same purpose with better and clear distinctive results. Biospy is a conclusive test and as such, it is important that a biopsy of the tissue is done to obtain specific information of the tumor cells. In this a tissue sample is removed from the breast for pathological tests. An open surgical biopsy or a stereotactic biopsy should be undertaken for best conclusive results in diagnosis. In case the cancer is invasive, sentinel lymph node biopsy would be done in which a lymph nodes under your arm (axillary lymph nodes) would be removed for pathological examination.