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Health condition · Clinically reviewed

Paget’s disease of the breast, the nipple change that isn’t eczema.

A rare form of breast cancer affecting the nipple skin - almost always with an underlying cancer beneath it. Early biopsy is what changes the outcome.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG12, breast cancer MDT standards and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK pathways for nipple-areola biopsy, surgical planning and adjuvant treatment.

Key facts

Paget’s disease of the breast, at a glance.

The essentials, in plain English - what it is, why it’s often missed, and how it’s treated in the UK today.

  • What it is

    A rare form of breast cancer affecting the nipple and areola skin - almost always with an underlying ductal carcinoma beneath it.

  • Not bone disease

    Entirely distinct from Paget’s disease of bone, despite sharing the name of Sir James Paget. Different organ, different disease.

  • Common pitfall

    Eczema-like changes to the nipple are frequently mistaken for dermatitis, delaying diagnosis by months.

  • Underlying cancer

    Ductal carcinoma in situ or invasive ductal carcinoma is found beneath the nipple in the vast majority of cases.

  • Key investigation

    A nipple skin biopsy is essential - it is the only way to reliably distinguish Paget’s disease from benign eczema.

  • Treatment

    Surgery is the mainstay - mastectomy or breast-conserving surgery with removal of the nipple-areola complex, guided by the underlying tumour.

Why this guide matters

A cancer that hides behind a common skin complaint.

Paget’s disease of the breast is rare, frequently misread as eczema, and treatable when caught early. The three points below shape everything else on this page.

  • It is a breast cancer, not a skin condition

    The nipple changes are the visible sign of a cancer sitting in the ducts beneath - not a primary skin disease, however it looks.

  • The name is a coincidence, not a link

    Paget’s disease of the breast has nothing to do with Paget’s disease of bone - only the surgeon who first described both shares the name.

  • Biopsy ends the guessing

    A nipple skin biopsy settles the diagnosis within days - it should follow, not replace, a trial of simple treatment that hasn’t worked.

How the diagnosis is made

From a nipple change to a confirmed plan.

The steps a UK breast clinic will normally follow under NICE NG12, in order - so you know what to expect and why.

  1. 01

    Assessing

    Nipple examination

    Redness, scaling, crusting or itching of the nipple and areola, sometimes with flattening or inversion - assessed against a trial of simple treatment.

  2. 02

    Assessing

    Two-week-wait referral

    Per NICE NG12, unexplained nipple changes that persist beyond a short trial of emollient or simple treatment warrant urgent referral to a breast clinic.

  3. 03

    Assessing

    Mammography and ultrasound

    Imaging of the breast tissue beneath the nipple to look for an underlying mass, calcification or ductal abnormality.

  4. 04

    Confirming

    Nipple skin biopsy

    A punch or wedge biopsy of the nipple skin - essential to confirm Paget cells and to distinguish this from eczema or dermatitis.

  5. 05

    Confirming

    Breast MRI

    Assesses the extent of the underlying disease when mammography and ultrasound findings are inconclusive or surgery is being planned.

  6. 06

    Preparing

    Specialist breast cancer MDT

    Results are reviewed by a multidisciplinary team who confirm staging and agree a surgical and oncological plan.

  7. 07

    Preparing

    Sentinel node and staging

    Axillary staging - typically sentinel lymph node biopsy - is arranged in line with the underlying cancer type before or alongside surgery.

Typical timeline: urgent referral to a confirmed diagnosis within two to four weeks.

Symptoms

What Paget’s disease actually looks like.

Signs that sit on the nipple and areola specifically - and the features that mean it’s time to ask for a biopsy, not another cream.

  • Eczema-like nipple changes

    Redness, scaling and crusting of the nipple skin - often the first and most easily mistaken sign.

  • Persistent itching or burning

    A sore, itchy or burning sensation confined to the nipple and areola, sometimes with mild pain.

  • Nipple discharge

    Clear, bloody or blood-stained discharge from the nipple - always worth urgent assessment.

  • Flattening or inversion

    A nipple that becomes flattened or draws inward where it previously did not - a structural change worth flagging.

  • Ulceration or crusting

    Skin breakdown, weeping or a crust that does not heal with simple moisturiser or steroid cream.

  • Underlying lump (sometimes)

    A palpable lump may or may not be felt - its absence does not rule out an underlying cancer.

  • Usually one-sided

    Almost always affects a single nipple - bilateral, symmetrical change points away from Paget’s disease.

  • Red flag - non-healing change

    Any nipple change lasting more than a few weeks despite simple treatment deserves urgent breast-clinic assessment.

Treatment

How Paget’s disease of the breast is treated.

Surgery to remove the nipple-areola complex and the underlying disease, with staging and adjuvant treatment guided by the underlying cancer.

  • Mastectomy

    Removal of the whole breast including the nipple-areola complex - considered when underlying disease is extensive or multifocal.

  • Breast-conserving surgery

    Wide local excision with removal of the nipple-areola complex, preserving the rest of the breast where the underlying disease is limited.

  • Sentinel lymph node biopsy

    Axillary staging performed alongside surgery when the underlying cancer is invasive, guiding further treatment decisions.

  • Radiotherapy

    Usually recommended after breast-conserving surgery, and sometimes after mastectomy, based on the underlying tumour’s features.

  • Chemotherapy

    Offered when the underlying invasive cancer’s size, grade or nodal status meets the threshold for systemic treatment.

  • Hormone therapy

    Tamoxifen or an aromatase inhibitor for oestrogen-receptor-positive underlying disease, continued for several years.

  • Oncoplastic reconstruction

    Immediate or delayed breast and nipple reconstruction options discussed as part of surgical planning.

  • MDT-led specialist care

    Every case is managed through a commissioned specialist breast cancer unit, coordinating surgery, oncology and reconstruction.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist breast cancer MDT standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or breast specialist knows your history and examination findings and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Suspected cancer: recognition and referral (NG12).

  • NICE. Early and locally advanced breast cancer: diagnosis and management (NG101).

  • Royal College of Radiologists / British Association of Surgical Oncology. Breast cancer MDT standards.

  • Cancer Research UK. Paget’s disease of the breast - patient information.

Red flags

When a nipple change needs urgent attention.

Most nipple changes are benign. These are the situations where waiting isn’t the right call - and where a 2-week-wait referral is needed.

  • Nipple change beyond 2 to 3 weeks

    Eczema-like changes that don’t settle with a short trial of simple treatment need urgent 2-week-wait referral.

  • Bloody nipple discharge

    Any blood-stained or spontaneous unilateral discharge deserves prompt breast-clinic assessment.

  • New nipple inversion or flattening

    A structural change to a previously normal nipple is a recognised warning sign, with or without visible skin change.

  • Misdiagnosis as simple dermatitis

    Failure to improve on topical steroids for presumed eczema of the nipple should prompt biopsy, not a longer trial of cream.

  • Palpable lump beneath the nipple

    Any lump found on examination or imaging alongside nipple change warrants urgent triple assessment.

  • Ulceration that won’t heal

    Persistent skin breakdown or a non-healing crust on the nipple is not typical of benign skin disease.

  • Delayed presentation

    Because it mimics eczema, Paget’s disease is often diagnosed later than other breast cancers - earlier biopsy avoids this delay.

  • Extensive underlying disease on MRI

    Widespread ductal involvement found on imaging usually shifts the surgical plan towards mastectomy.

  • Axillary node involvement

    Palpable or imaging-detected nodal disease changes staging and the need for systemic treatment.

Living with it

A rare diagnosis, with a clear pathway.

Four things that make the biggest difference through diagnosis and treatment - acting early, insisting on biopsy, working with the MDT, and staying on top of follow-up.

A quiet reminder

A rare diagnosis is still a well-understood one.

Paget’s disease of the breast is uncommon, but the pathway to diagnose and treat it is well established and follows the same standards as any other breast cancer.

  1. 01 Act early

    Don’t wait out a “bit of eczema”

    If a steroid cream hasn’t settled a nipple change within a couple of weeks, ask for a breast-clinic referral rather than a second cream.

  2. 02 Biopsy

    Push for a biopsy if unsure

    A nipple skin biopsy is quick and is the only reliable way to rule Paget’s disease in or out - it’s reasonable to ask for one directly.

  3. 03 MDT

    Expect a team, not one doctor

    Surgery, oncology, pathology and reconstruction teams work together through the MDT - you’ll usually meet more than one specialist.

  4. 04 Follow-up

    Plan for long-term surveillance

    Regular clinical review and imaging continue for years after treatment, as with any breast cancer diagnosis.

Frequently asked

Everything we get asked about Paget’s disease of the breast.

Quick answers on diagnosis, the name confusion, biopsy and treatment choices.

  • What is Paget’s disease of the breast?

    A rare form of breast cancer that affects the skin of the nipple and areola. It is almost always associated with an underlying ductal carcinoma in situ or invasive ductal carcinoma in the breast tissue beneath the nipple.

  • Is this the same as Paget’s disease of bone?

    No - despite sharing the name of the same 19th-century surgeon, Sir James Paget, these are entirely different diseases. Paget’s disease of bone is a benign condition of abnormal bone remodelling, while Paget’s disease of the breast is a form of breast cancer.

  • Why is it often mistaken for eczema?

    Because the nipple skin becomes red, scaly, crusted and itchy - a presentation that closely resembles eczema or dermatitis. This is a well-recognised diagnostic pitfall that can delay biopsy and diagnosis if the change is simply treated with steroid cream.

  • Do I always need a biopsy?

    Yes, in effect - a nipple skin biopsy is essential to confirm the diagnosis, because imaging and examination alone cannot reliably distinguish Paget’s disease from benign skin conditions of the nipple.

  • Will I need a mastectomy?

    Not always. Some people are suitable for breast-conserving surgery with removal of the nipple-areola complex, depending on how extensive the underlying disease is on imaging and biopsy. Others need a mastectomy. The specialist MDT agrees the best option for each person.

  • What determines whether I need chemotherapy or hormone therapy?

    These decisions are guided by the characteristics of the underlying breast cancer found beneath the nipple - its size, grade, hormone-receptor status and lymph node involvement - exactly as for any other breast cancer.

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