Beware a rash that doesn’t respond

This nipple is red and scaly and there is spread of the rash on to the areola medially with some extension on to the breast skin.

The rash was treated with topical steroids and antifungal creams but with no response over a period of two years.

A skin biopsy was taken and reported as Bowen’s disease or SCC in situ and the patient was referred to a dermatologist for treatment.

A sun-induced skin cancer on the surface of the nipple is highly unusual. The history and slow growth was very suggestive of mammary Paget’s disease, a cancer of the breast ducts that spreads out