{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T22:04:23Z","timestamp":1782252263666,"version":"3.54.5"},"reference-count":15,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Mammary Paget disease (MPD) is a rare cutaneous malignancy associated with underlying ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC). Clinically, it appears as eczematous changes in the nipple and areola complex (NAC), which may include itching, redness, crusting, and ulceration; these symptoms can sometimes mimic benign dermatologic conditions such as nipple eczema, making early diagnosis challenging. A 56-year-old woman presented with persistent erythema and scaling of the left nipple, which did not respond to conventional dermatologic treatments: a high degree of suspicion prompted further investigation. Reflectance confocal microscopy (RCM) revealed atypical, enlarged epidermal cells with irregular boundaries, while line-field confocal\u2013optical coherence tomography (LC-OCT) demonstrated thickening of the epidermis, hypo-reflective vacuous spaces and abnormally large round cells (Paget cells). These non-invasive imaging findings were consistent with an aggressive case of Paget disease despite the absence of clear mammographic evidence of underlying carcinoma: in fact, several biopsies were needed, and at the end, massive surgery was necessary. Non-invasive imaging techniques, such as dermoscopy, RCM, and LC-OCT, offer a valuable diagnostic tool in detecting Paget disease, especially in early stages and atypical forms.<\/jats:p>","DOI":"10.3390\/diagnostics15151898","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T12:39:29Z","timestamp":1753792769000},"page":"1898","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Multimodal Imaging Detection of Difficult Mammary Paget Disease: Dermoscopy, Reflectance Confocal Microscopy, and Line-Field Confocal\u2013Optical Coherence Tomography"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2181-951X","authenticated-orcid":false,"given":"Carmen","family":"Cantisani","sequence":"first","affiliation":[{"name":"UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Caruso","sequence":"additional","affiliation":[{"name":"Unit of Cellular Pathology, San Filippo Neri Hospital of Rome, 00135 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0811-7601","authenticated-orcid":false,"given":"Alberto","family":"Taliano","sequence":"additional","affiliation":[{"name":"UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8218-3896","authenticated-orcid":false,"given":"Caterina","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41121 Modena, Italy"},{"name":"Azienda Unit\u00e0 Sanitaria Locale\u2014IRCCS di Reggio Emilia, Skin Cancer Center, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rizzuto","sequence":"additional","affiliation":[{"name":"UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5709-2530","authenticated-orcid":false,"given":"Vito","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"General Surgery Department of Surgery, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7262-2456","authenticated-orcid":false,"given":"Pawel","family":"Pietkiewicz","sequence":"additional","affiliation":[{"name":"Zwierzyniecka Medical Center, 60-814 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Bortone","sequence":"additional","affiliation":[{"name":"UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Gargano","sequence":"additional","affiliation":[{"name":"UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Suppa","sequence":"additional","affiliation":[{"name":"Department of Dermatology, H\u00f4pital Erasme\u2014H\u00f4pitaux Universitaires de Bruxelles (HUB), 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pellacani","sequence":"additional","affiliation":[{"name":"UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Markarian, S., and Holmes, D.R. (2022). Mammary Paget\u2019s Disease: An Update. Cancers, 14.","DOI":"10.3390\/cancers14102422"},{"key":"ref_2","first-page":"e65378","article-title":"Mammary Paget\u2019s Disease Mimicking Benign and Malignant Dermatological Conditions: Clinical Challenges and Diagnostic Considerations","volume":"16","author":"Altaf","year":"2024","journal-title":"Cureus"},{"key":"ref_3","first-page":"1","article-title":"Paget\u2019s disease of the breast: Diagnosis and management","volume":"84","author":"Cox","year":"2023","journal-title":"Br. J. Hosp. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1111\/jdv.15732","article-title":"Dermoscopic features of mammary Paget\u2019s disease: A retrospective case-control study by the International Dermoscopy Society","volume":"33","author":"Apalla","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"365","DOI":"10.5021\/ad.2017.29.3.365","article-title":"Dermoscopy as a Supportive Instrument in the Early Recognition of Erosive Adenomatosis of the Nipple and Mammary Paget\u2019s Disease","volume":"29","author":"Errichetti","year":"2017","journal-title":"Ann. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1590\/S0365-05962013000200023","article-title":"Polarized dermoscopy of mammary Paget disease","volume":"88","author":"Crignis","year":"2013","journal-title":"Bras. Dermatol."},{"key":"ref_7","first-page":"9235","article-title":"Pigmentary Mammary Paget Disease: Clinical, dermoscopical and histological challenge","volume":"13","author":"Iozzo","year":"2021","journal-title":"Dermatol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.1016\/j.jaad.2010.09.717","article-title":"Pigmented mammary Paget disease mimicking melanoma on dermatoscopy","volume":"64","author":"Yanagishita","year":"2011","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2020.05.153","article-title":"Reflectance confocal microscopy","volume":"84","author":"Shahriari","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.sder.2009.06.004","article-title":"Reflectance Confocal Microscopy\u2014State-of-Art and Research Overview","volume":"28","author":"Wurm","year":"2009","journal-title":"Semin. Cutan. Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.jdcr.2018.09.019","article-title":"Introduction to reflectance confocal microscopy and its use in clinical practice","volume":"4","author":"Levine","year":"2018","journal-title":"JAAD Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cinotti, E., Brunetti, T., Cartocci, A., Tognetti, L., Suppa, M., Malvehy, J., Perez-Anker, J., Puig, S., Perrot, J.L., and Rubegni, P. (2023). Diagnostic Accuracy of Line-Field Confocal Optical Coherence Tomography for the Diagnosis of Skin Carcinomas. Diagnostics, 13.","DOI":"10.3390\/diagnostics13030361"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1111\/j.1365-2133.2011.10380.x","article-title":"Noninvasive differentiation between mamillary eczema and Paget disease by in vivo reflectance confocal microscopy on the basis of two case reports","volume":"165","author":"Richtig","year":"2011","journal-title":"Br. J. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Dubois, A., Levecq, O., Azimani, H., Siret, D., Barut, A., Suppa, M., Del Marmol, V., Malvehy, J., Cinotti, E., and Rubegni, P. (2018). Line-field confocal optical coherence tomography for high-resolution noninvasive imaging of skin tumors. J. Biomed. Opt., 23.","DOI":"10.1117\/1.JBO.23.10.106007"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"8853","DOI":"10.3390\/curroncol30100639","article-title":"Line-Field Confocal Optical Coherence Tomography for the Diagnosis of Skin Carcinomas: Real-Life Data over Three Years","volume":"30","author":"Donelli","year":"2023","journal-title":"Curr. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/15\/1898\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:17:57Z","timestamp":1760033877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/15\/1898"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":15,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15151898"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15151898","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]}}}