Damian presents with a six-month history of right nipple change. 

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Damian is a 64-year-old retired labourer. He has a history of spinal stenosis, chronic pain and traumatic brain injury. His medications include duloxetine and tapentadol.

Damian presents with a six-month history of right nipple change. It is darker, mildly itchy and feels much thicker than the left. There is no nipple discharge. He has no pain but is concerned about what is causing the change.