{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:01:48Z","timestamp":1784779308887,"version":"3.55.0"},"reference-count":38,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,1]]},"abstract":"\n Context<\/jats:italic>\n .\u2014Paget disease is an uncommon skin manifestation of breast cancer, associated with either invasive carcinoma or ductal carcinoma in situ in the underlying breast. In very rare cases, tumor cells within the epidermis invade through the basement membrane of the skin into the dermis.\n <\/jats:p>\n \n Objectives<\/jats:italic>\n .\u2014To identify a series of cases of Paget disease with direct dermal invasion and to investigate the clinicopathologic features and outcome.\n <\/jats:p>\n \n Design<\/jats:italic>\n .\u2014Cases were identified during a 6-year period from the files of 2 hospitals. The clinical histories, imaging studies, and pathology reports were reviewed.\n <\/jats:p>\n \n Results<\/jats:italic>\n .\u2014Seven patients were identified, 5 with microinvasion (<0.1\u00a0cm) and 2 with 0.2- or 0.3-cm invasive carcinomas in the dermis. No lymphovascular invasion was seen. Sentinel nodes were negative in 3 patients who underwent biopsy. Five patients were treated with breast conservation with radiation. Three patients were at high risk for breast cancer because of prior breast cancer, Li-Fraumeni syndrome, or radiation for Hodgkin disease. The latter 2 patients underwent bilateral mastectomies. Three patients received hormonal therapy and 1 oophorectomy. No patient received chemotherapy. At follow-ups ranging from 4 to 66\u00a0months (median, 20\u00a0months), there have been no recurrences.\n <\/jats:p>\n \n Conclusions<\/jats:italic>\n .\u2014Patients with direct dermal invasion from Paget disease had a favorable outcome during the available follow-up period. This type of dermal involvement must be distinguished from locally advanced invasive carcinomas with skin invasion classified as T4b in the American Joint Cancer Commission staging system, as cancers with other types of skin invasion are associated with a poor prognosis.\n <\/jats:p>","DOI":"10.5858\/arpa.2011-0611-oa","type":"journal-article","created":{"date-parts":[[2012,12,31]],"date-time":"2012-12-31T14:51:17Z","timestamp":1356965477000},"page":"72-76","source":"Crossref","is-referenced-by-count":22,"title":["Paget Disease of the Breast With Invasion From Nipple Skin Into the Dermis: An Unusual Type of Skin Invasion Not Associated With an Adverse Outcome"],"prefix":"10.5858","volume":"137","author":[{"given":"Mary Ann","family":"Sanders","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Dominici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Denison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehra","family":"Golshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tad","family":"Wiecorek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan C.","family":"Lester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"key":"i1543-2165-137-1-72-b01","series-title":"St Bartholomews Hosp Rep","first-page":"87","article-title":"On disease of the mammary areola preceding cancer of the mammary gland","volume":"10","author":"Paget\n J","year":"1874","unstructured":"Paget\n J\n \n . On disease of the mammary areola preceding cancer of the mammary gland . St Bartholomews Hosp Rep . 1874 ;10 :87 \u201389 ."},{"key":"i1543-2165-137-1-72-b02","series-title":"Rosen's Breast Pathology. 3rd ed","first-page":"621","article-title":"Paget's disease of the nipple","author":"Rosen\n PP.","year":"2009","unstructured":"Rosen\n PP.\n \n \n Paget's disease of the nipple . In : RosenPP . Rosen's Breast Pathology. 3rd ed . Philadelphia, PA : Lippincott Williams & Wilkins ; 2009 :621 \u2013636 ."},{"key":"i1543-2165-137-1-72-b03","series-title":"Diagnostic Pathology: Breast. 1st ed","first-page":"28","article-title":"Ductal carcinoma in situ, Paget disease","author":"Hicks\n DG ,","year":"2011","unstructured":"Hicks\n DG , \n \n Lester\n SC.\n \n \n Ductal carcinoma in situ, Paget disease . In : HicksDG , LesterSC , authors. Diagnostic Pathology: Breast. 1st ed . Salt Lake City, UT : Amirsys ; 2011 : 28 \u201335 . Diagnostic Pathology."},{"issue":"7","key":"i1543-2165-137-1-72-b04","series-title":"Cancer","first-page":"1448","article-title":"Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S","volume":"107","author":"Chen\n CY ,","year":"2006","unstructured":"Chen\n CY , \n \n Sun\n LM , \n \n Anderson\n BO\n \n . Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S . Cancer . 2006 ;107 (7 ):1448 \u20131458 ."},{"issue":"3","key":"i1543-2165-137-1-72-b05","series-title":"Breast J","first-page":"254","article-title":"Paget's disease of the male breast: an unusual case of dermal invasion","volume":"9","author":"Chao\n C ,","year":"2003","unstructured":"Chao\n C , \n \n Edwards\n MJ , \n \n Wolfson\n S , \n \n Sewell\n C , \n \n Edwards\n D , \n \n McMasters\n KM\n \n . Paget's disease of the male breast: an unusual case of dermal invasion . Breast J . 2003 ;9 (3 ):254 ."},{"issue":"5","key":"i1543-2165-137-1-72-b06","series-title":"Am J Dermatopathol","first-page":"e54","article-title":"Pigmented Paget disease of the breast nipple with underlying infiltrating carcinoma: a case report and review of the literature","volume":"33","author":"Soler\n T ,","year":"2011","unstructured":"Soler\n T , \n \n Lerin\n A , \n \n Serrano\n T , \n \n Masferrer\n E , \n \n Garcia-Tejedor\n A , \n \n Condom\n E\n \n . Pigmented Paget disease of the breast nipple with underlying infiltrating carcinoma: a case report and review of the literature . Am J Dermatopathol . 2011 ;33 (5 ):e54 \u2013e57 ."},{"key":"i1543-2165-137-1-72-b07","article-title":"AJCC Cancer Staging Manual, editions 1 through 7","unstructured":"American Joint Committee on Cancer Web site . AJCC Cancer Staging Manual, editions 1 through 7 . www.cancerstaging.org\/products\/pasteditions.html. Accessed August 21, 2011."},{"issue":"2","key":"i1543-2165-137-1-72-b08","series-title":"Breast Cancer Res Treat","first-page":"137","article-title":"Paget's disease of the breast: accuracy of preoperative assessment","volume":"102","author":"Zakaria\n S ,","year":"2007","unstructured":"Zakaria\n S , \n \n Pantvaidya\n G , \n \n Ghosh\n K , \n \n Degnim\n AC\n \n . Paget's disease of the breast: accuracy of preoperative assessment . Breast Cancer Res Treat . 2007 ;102 (2 ):137 \u2013142 ."},{"issue":"2","key":"i1543-2165-137-1-72-b09","series-title":"J Am Coll Surg","first-page":"316","article-title":"MRI identifies otherwise occult disease in select patients with Paget disease of the nipple","volume":"206","author":"Morrogh\n M ,","year":"2008","unstructured":"Morrogh\n M , \n \n Morris\n EA , \n \n Liberman\n L , \n \n Van Zee\n K , \n \n Cody III\n HS , \n \n King\n T\n \n . MRI identifies otherwise occult disease in select patients with Paget disease of the nipple . J Am Coll Surg . 2008 ;206 (2 ):316 \u2013321 ."},{"issue":"6","key":"i1543-2165-137-1-72-b10","series-title":"Invest Radiol","first-page":"363","article-title":"Paget disease of the breast: findings at magnetic resonance imaging and histopathologic correlation","volume":"40","author":"Frei\n KA ,","year":"2005","unstructured":"Frei\n KA , \n \n Bonel\n HM , \n \n Pelte\n MF , \n \n Hylton\n NM , \n \n Kinkel\n K\n \n . Paget disease of the breast: findings at magnetic resonance imaging and histopathologic correlation . Invest Radiol . 2005 ;40 (6 ):363 \u2013367 ."},{"issue":"4","key":"i1543-2165-137-1-72-b11","series-title":"Histopathology","first-page":"564","article-title":"HER2 molecular subtype is a dominant subtype of mammary Paget's cells: an immunohistochemical study","volume":"57","author":"Sek\n P ,","year":"2010","unstructured":"Sek\n P , \n \n Zawrocki\n A , \n \n Biernat\n W , \n \n Piekarski\n JH\n \n . HER2 molecular subtype is a dominant subtype of mammary Paget's cells: an immunohistochemical study . Histopathology . 2010 ;57 (4 ):564 \u2013571 ."},{"key":"i1543-2165-137-1-72-b12","series-title":"Am J Surg","article-title":"Modern surgical approach to Paget's disease","author":"Dominici\n L ,","year":"2011","unstructured":"Dominici\n L , \n \n Lester\n S , \n \n Guo\n L , \n \n Specht\n M , \n \n Smith\n B , \n \n Golshan\n M\n \n . Modern surgical approach to Paget's disease . Am J Surg . 2011 . 2011 Oct. 7 [Epub ahead of print]."},{"issue":"3","key":"i1543-2165-137-1-72-b13","series-title":"Ann Surg Oncol","first-page":"863","article-title":"The lymphatic anatomy of the breast and its implications for sentinel node biopsy: a human cadaver study","volume":"15","author":"Suami\n H ,","year":"2008","unstructured":"Suami\n H , \n \n Pan\n WR , \n \n Mann\n GB , \n \n Taylor\n GI\n \n . The lymphatic anatomy of the breast and its implications for sentinel node biopsy: a human cadaver study . Ann Surg Oncol . 2008 ;15 (3 ):863 \u2013871 ."},{"issue":"2","key":"i1543-2165-137-1-72-b14","series-title":"Clin Breast Cancer","first-page":"86","article-title":"A three-dimensional analysis of the lymphatics of a bilateral breast specimen: a human cadaveric study","volume":"9","author":"Pan\n WR ,","year":"2009","unstructured":"Pan\n WR , \n \n Rozen\n WM , \n \n Stella\n DL , \n \n Ashton\n MW\n \n . A three-dimensional analysis of the lymphatics of a bilateral breast specimen: a human cadaveric study . Clin Breast Cancer . 2009 ;9 (2 ):86 \u201391 ."},{"issue":"1","key":"i1543-2165-137-1-72-b15","first-page":"59","article-title":"Breast cancer with non-inflammatory skin involvement: current data on an underreported entity and its problematic classification. Breast","volume":"19","author":"Guth\n U ,","year":"2010","unstructured":"Guth\n U , \n \n Huang\n DJ , \n \n Schotzau\n A , \n \n Dirnhofer\n S , \n \n Wight\n E , \n \n Singer\n G\n \n . Breast cancer with non-inflammatory skin involvement: current data on an underreported entity and its problematic classification. Breast . 2010 ;19 (1 ):59 \u201364 ."},{"issue":"1","key":"i1543-2165-137-1-72-b16","series-title":"Breast J","first-page":"47","article-title":"The prognosis of tumors with only microscopic skin involvement without clinical T4b signs is significantly better than T4b tumors in breast carcinoma","volume":"17","author":"Duraker\n N ,","year":"2011","unstructured":"Duraker\n N , \n \n Bati\n B , \n \n Caynak\n ZC , \n \n Demir\n D , \n \n Kurtulus\n I\n \n . The prognosis of tumors with only microscopic skin involvement without clinical T4b signs is significantly better than T4b tumors in breast carcinoma . Breast J . 2011 ;17 (1 ):47 \u201355 ."},{"issue":"10","key":"i1543-2165-137-1-72-b17","series-title":"Ann Oncol","first-page":"1618","article-title":"Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey","volume":"16","author":"Guth\n U ,","year":"2005","unstructured":"Guth\n U , \n \n Singer\n G , \n \n Schotzau\n A\n , et al . \n Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey . Ann Oncol . 2005 ;16 (10 ):1618 \u20131623 ."},{"key":"i1543-2165-137-1-72-b18","series-title":"World J Surg Oncol","first-page":"10","article-title":"Skin invasion and prognosis in node negative breast cancer: a retrospective study","volume":"6","author":"Tada\n K ,","year":"2008","unstructured":"Tada\n K , \n \n Morizono\n H , \n \n Iijima\n K\n , et al . \n Skin invasion and prognosis in node negative breast cancer: a retrospective study . World J Surg Oncol . 2008 ;6 :10 \u201315 ."},{"key":"i1543-2165-137-1-72-b19","series-title":"Diseases of the Breast. 3rd ed","author":"Haagensen\n CD","year":"1986","unstructured":"Haagensen\n CD\n \n . Diseases of the Breast. 3rd ed . Philadelphia, PA : WB Saunders Co ; 1986 ."},{"key":"i1543-2165-137-1-72-b01","series-title":"St Bartholomews Hosp Rep","first-page":"87","article-title":"On disease of the mammary areola preceding cancer of the mammary gland","volume":"10","author":"Paget\n J","year":"1874","unstructured":"Paget\n J\n \n . On disease of the mammary areola preceding cancer of the mammary gland . St Bartholomews Hosp Rep . 1874 ;10 :87 \u201389 ."},{"key":"i1543-2165-137-1-72-b02","series-title":"Rosen's Breast Pathology. 3rd ed","first-page":"621","article-title":"Paget's disease of the nipple","author":"Rosen\n PP.","year":"2009","unstructured":"Rosen\n PP.\n \n \n Paget's disease of the nipple . In : RosenPP . Rosen's Breast Pathology. 3rd ed . Philadelphia, PA : Lippincott Williams & Wilkins ; 2009 :621 \u2013636 ."},{"key":"i1543-2165-137-1-72-b03","series-title":"Diagnostic Pathology: Breast. 1st ed","first-page":"28","article-title":"Ductal carcinoma in situ, Paget disease","author":"Hicks\n DG ,","year":"2011","unstructured":"Hicks\n DG , \n \n Lester\n SC.\n \n \n Ductal carcinoma in situ, Paget disease . In : HicksDG , LesterSC , authors. Diagnostic Pathology: Breast. 1st ed . Salt Lake City, UT : Amirsys ; 2011 : 28 \u201335 . Diagnostic Pathology."},{"issue":"7","key":"i1543-2165-137-1-72-b04","series-title":"Cancer","first-page":"1448","article-title":"Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S","volume":"107","author":"Chen\n CY ,","year":"2006","unstructured":"Chen\n CY , \n \n Sun\n LM , \n \n Anderson\n BO\n \n . Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S . Cancer . 2006 ;107 (7 ):1448 \u20131458 ."},{"issue":"3","key":"i1543-2165-137-1-72-b05","series-title":"Breast J","first-page":"254","article-title":"Paget's disease of the male breast: an unusual case of dermal invasion","volume":"9","author":"Chao\n C ,","year":"2003","unstructured":"Chao\n C , \n \n Edwards\n MJ , \n \n Wolfson\n S , \n \n Sewell\n C , \n \n Edwards\n D , \n \n McMasters\n KM\n \n . Paget's disease of the male breast: an unusual case of dermal invasion . Breast J . 2003 ;9 (3 ):254 ."},{"issue":"5","key":"i1543-2165-137-1-72-b06","series-title":"Am J Dermatopathol","first-page":"e54","article-title":"Pigmented Paget disease of the breast nipple with underlying infiltrating carcinoma: a case report and review of the literature","volume":"33","author":"Soler\n T ,","year":"2011","unstructured":"Soler\n T , \n \n Lerin\n A , \n \n Serrano\n T , \n \n Masferrer\n E , \n \n Garcia-Tejedor\n A , \n \n Condom\n E\n \n . Pigmented Paget disease of the breast nipple with underlying infiltrating carcinoma: a case report and review of the literature . Am J Dermatopathol . 2011 ;33 (5 ):e54 \u2013e57 ."},{"key":"i1543-2165-137-1-72-b07","article-title":"AJCC Cancer Staging Manual, editions 1 through 7","unstructured":"American Joint Committee on Cancer Web site . AJCC Cancer Staging Manual, editions 1 through 7 . www.cancerstaging.org\/products\/pasteditions.html. Accessed August 21, 2011."},{"issue":"2","key":"i1543-2165-137-1-72-b08","series-title":"Breast Cancer Res Treat","first-page":"137","article-title":"Paget's disease of the breast: accuracy of preoperative assessment","volume":"102","author":"Zakaria\n S ,","year":"2007","unstructured":"Zakaria\n S , \n \n Pantvaidya\n G , \n \n Ghosh\n K , \n \n Degnim\n AC\n \n . Paget's disease of the breast: accuracy of preoperative assessment . Breast Cancer Res Treat . 2007 ;102 (2 ):137 \u2013142 ."},{"issue":"2","key":"i1543-2165-137-1-72-b09","series-title":"J Am Coll Surg","first-page":"316","article-title":"MRI identifies otherwise occult disease in select patients with Paget disease of the nipple","volume":"206","author":"Morrogh\n M ,","year":"2008","unstructured":"Morrogh\n M , \n \n Morris\n EA , \n \n Liberman\n L , \n \n Van Zee\n K , \n \n Cody III\n HS , \n \n King\n T\n \n . MRI identifies otherwise occult disease in select patients with Paget disease of the nipple . J Am Coll Surg . 2008 ;206 (2 ):316 \u2013321 ."},{"issue":"6","key":"i1543-2165-137-1-72-b10","series-title":"Invest Radiol","first-page":"363","article-title":"Paget disease of the breast: findings at magnetic resonance imaging and histopathologic correlation","volume":"40","author":"Frei\n KA ,","year":"2005","unstructured":"Frei\n KA , \n \n Bonel\n HM , \n \n Pelte\n MF , \n \n Hylton\n NM , \n \n Kinkel\n K\n \n . Paget disease of the breast: findings at magnetic resonance imaging and histopathologic correlation . Invest Radiol . 2005 ;40 (6 ):363 \u2013367 ."},{"issue":"4","key":"i1543-2165-137-1-72-b11","series-title":"Histopathology","first-page":"564","article-title":"HER2 molecular subtype is a dominant subtype of mammary Paget's cells: an immunohistochemical study","volume":"57","author":"Sek\n P ,","year":"2010","unstructured":"Sek\n P , \n \n Zawrocki\n A , \n \n Biernat\n W , \n \n Piekarski\n JH\n \n . HER2 molecular subtype is a dominant subtype of mammary Paget's cells: an immunohistochemical study . Histopathology . 2010 ;57 (4 ):564 \u2013571 ."},{"key":"i1543-2165-137-1-72-b12","series-title":"Am J Surg","article-title":"Modern surgical approach to Paget's disease","author":"Dominici\n L ,","year":"2011","unstructured":"Dominici\n L , \n \n Lester\n S , \n \n Guo\n L , \n \n Specht\n M , \n \n Smith\n B , \n \n Golshan\n M\n \n . Modern surgical approach to Paget's disease . Am J Surg . 2011 . 2011 Oct. 7 [Epub ahead of print]."},{"issue":"3","key":"i1543-2165-137-1-72-b13","series-title":"Ann Surg Oncol","first-page":"863","article-title":"The lymphatic anatomy of the breast and its implications for sentinel node biopsy: a human cadaver study","volume":"15","author":"Suami\n H ,","year":"2008","unstructured":"Suami\n H , \n \n Pan\n WR , \n \n Mann\n GB , \n \n Taylor\n GI\n \n . The lymphatic anatomy of the breast and its implications for sentinel node biopsy: a human cadaver study . Ann Surg Oncol . 2008 ;15 (3 ):863 \u2013871 ."},{"issue":"2","key":"i1543-2165-137-1-72-b14","series-title":"Clin Breast Cancer","first-page":"86","article-title":"A three-dimensional analysis of the lymphatics of a bilateral breast specimen: a human cadaveric study","volume":"9","author":"Pan\n WR ,","year":"2009","unstructured":"Pan\n WR , \n \n Rozen\n WM , \n \n Stella\n DL , \n \n Ashton\n MW\n \n . A three-dimensional analysis of the lymphatics of a bilateral breast specimen: a human cadaveric study . Clin Breast Cancer . 2009 ;9 (2 ):86 \u201391 ."},{"issue":"1","key":"i1543-2165-137-1-72-b15","first-page":"59","article-title":"Breast cancer with non-inflammatory skin involvement: current data on an underreported entity and its problematic classification. Breast","volume":"19","author":"Guth\n U ,","year":"2010","unstructured":"Guth\n U , \n \n Huang\n DJ , \n \n Schotzau\n A , \n \n Dirnhofer\n S , \n \n Wight\n E , \n \n Singer\n G\n \n . Breast cancer with non-inflammatory skin involvement: current data on an underreported entity and its problematic classification. Breast . 2010 ;19 (1 ):59 \u201364 ."},{"issue":"1","key":"i1543-2165-137-1-72-b16","series-title":"Breast J","first-page":"47","article-title":"The prognosis of tumors with only microscopic skin involvement without clinical T4b signs is significantly better than T4b tumors in breast carcinoma","volume":"17","author":"Duraker\n N ,","year":"2011","unstructured":"Duraker\n N , \n \n Bati\n B , \n \n Caynak\n ZC , \n \n Demir\n D , \n \n Kurtulus\n I\n \n . The prognosis of tumors with only microscopic skin involvement without clinical T4b signs is significantly better than T4b tumors in breast carcinoma . Breast J . 2011 ;17 (1 ):47 \u201355 ."},{"issue":"10","key":"i1543-2165-137-1-72-b17","series-title":"Ann Oncol","first-page":"1618","article-title":"Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey","volume":"16","author":"Guth\n U ,","year":"2005","unstructured":"Guth\n U , \n \n Singer\n G , \n \n Schotzau\n A\n , et al . \n Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey . Ann Oncol . 2005 ;16 (10 ):1618 \u20131623 ."},{"key":"i1543-2165-137-1-72-b18","series-title":"World J Surg Oncol","first-page":"10","article-title":"Skin invasion and prognosis in node negative breast cancer: a retrospective study","volume":"6","author":"Tada\n K ,","year":"2008","unstructured":"Tada\n K , \n \n Morizono\n H , \n \n Iijima\n K\n , et al . \n Skin invasion and prognosis in node negative breast cancer: a retrospective study . World J Surg Oncol . 2008 ;6 :10 \u201315 ."},{"key":"i1543-2165-137-1-72-b19","series-title":"Diseases of the Breast. 3rd ed","author":"Haagensen\n CD","year":"1986","unstructured":"Haagensen\n CD\n \n . Diseases of the Breast. 3rd ed . 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