Breast itching, ulceration, bloody discharge (375/1700)

A 48yo lady presents with itching, excoriations, redness, bloody discharge and ulceration around her nipple. What is the most likely dx?
a. Paget’s disease of the breast
b. Fibrocystic dysplasia
c. Breast abscess
d. Duct papilloma
e. Eczema

answer: A

Paget’s disease (1-3%)
Ductal carcinoma that invades nipple with scaling, eczematoid lesion. Malignant epithelial (Paget) cells infiltrate and proliferate in the epidermis, causing thickening of the nipple and the areolar skin. These tumorous glandular epithelial cells are derived from luminal lactiferous ductal epithelium of the breast tissue.

Erythema(sharply demarcated unlike eczema)
Burning sensation
Oozing with serosanguineous discharge
Some combination of the above symptoms

Early symptoms and signs of mammary PD include the following:

Excoriation from itching
Resolution and recurrence of small vesicles within the skin lesion