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Breast OSCE Examination Quiz
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A 63-year-old woman has a persistent red, scaly lesion that began on the right nipple and spread onto the areola. It has not resolved with treatment for eczema, and no breast lump is palpable. Which diagnosis most needs to be excluded?
- A Fibroadenoma You picked ✕
- B Intraductal papilloma You picked ✕
- C Mammary duct ectasia You picked ✕
- D Paget's disease of the nipple You picked ✓
- E Lactational mastitis You picked ✕
Correct!
Incorrect
The answer is D: Paget's disease of the nipple
Explanation
Why D is correct
See Nipple-Areolar Complex. Option D is correct: Paget's disease of the nipple must be excluded. The NHS describes it as a rare condition that causes eczema-like changes to the skin of the nipple and the areola (the darker skin around it), and it is usually a sign of breast cancer in the tissue behind the nipple. It always starts in the nipple and may extend to the areola, usually on one side, as a red, scaly rash. Its appearance is often similar to eczema or psoriasis, which is why it is missed. Around half of women with it have a lump behind the nipple, and in 9 out of 10 of those the lump is an invasive breast cancer. This means that the absence of a lump does not make the lesion reassuring. A rash on the nipple that does not settle with treatment, particularly if it affects one side only, should lead to a specialist referral and a tissue diagnosis (a biopsy) rather than another course of eczema treatment. Memory aid: eczema of the nipple that will not settle is Paget's until proven otherwise.
- Diagnosis: Paget's disease of the nipple, usually a sign of breast cancer in the tissue behind the nipple.
- Appearance: an eczema-like red, scaly rash that always starts in the nipple, usually on one side.
- Action: a rash that does not settle needs specialist referral and a biopsy, not another course of eczema treatment.
Why the other options are incorrect
- A. Fibroadenoma: A fibroadenoma is a benign, smooth, mobile breast lump. It is not a cause of persistent scaling of the nipple. Your answer
- B. Intraductal papilloma: An intraductal papilloma is a small growth in a milk duct that can cause discharge from one duct, which may be bloody. It does not cause a scaly nipple rash. Your answer
- C. Mammary duct ectasia: Duct ectasia is widening of the milk ducts and tends to cause discharge or a nipple that turns inwards. It does not explain a persistent scaly rash that begins on the nipple. Your answer
- E. Lactational mastitis: Lactational mastitis is a painful, inflamed breast in someone who is breastfeeding. This is a long-lasting scaly lesion in a 63-year-old, so the setting and course are different. Your answer
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More questions from this set. Start the quiz to answer them and see each explanation.
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1
A woman in her late forties has breasts that look alike when her hands rest on her thighs. Pressing her hands onto her hips brings out a small dimple in the upper outer quadrant of the left breast, and when she leans forward that breast does not fall as freely as the right. What best explains these linked findings?
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2
A 36-year-old woman reports a left breast lump. You have explained the examination, obtained consent, offered a chaperone and completed inspection. Which approach best provides a systematic palpation examination?
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