Paget's Disease of the Breast: Symptoms, Causes, and Treatment — A Clear Guide to Understanding and Managing the Condition

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026

TL;DR

Paget's disease of the breast is a rare form of breast cancer that affects the nipple, often causing scaly or crusty skin that resembles eczema. Most people with this condition also have breast cancer within the breast tissue, so diagnosis always involves imaging and a biopsy. It is not related to Paget's disease of the bone — the two conditions share only a name. Treatment mirrors other breast cancers and typically includes surgery, radiation therapy, and medications such as chemotherapy or hormone therapy. Any persistent nipple change deserves prompt medical evaluation.

Quick Answer

What is Paget's disease of the breast and how is it treated?

• Paget's disease of the breast is a rare form of breast cancer affecting the nipple, often producing scaly or crusty skin that spreads slowly to the areola.

• Most people with this condition also have breast cancer in the breast tissue, so evaluation includes imaging tests and a biopsy.

• The exact cause is unclear; experts theorize cancer either starts in the breast tissue and spreads through the milk ducts to the nipple, or starts in the nipple itself.

• It shares a name with Paget's disease of the bone but is a completely different condition.

• Symptoms usually affect one breast only and include flaky nipple skin, itching, burning, and straw-colored or bloody discharge.

• Treatment is similar to other breast cancers: surgery (lumpectomy or mastectomy), radiation therapy, chemotherapy, and hormone therapy.

• Any new or persistent nipple change should be evaluated by a healthcare professional right away.

What Is Paget's Disease of the Breast?

Paget's disease of the breast (pronounced PAJ-its, also called mammary Paget's disease) is a rare form of breast cancer that affects the nipple. It most often causes scaly or crusty skin on the nipple, and the affected area may slowly grow to involve the skin around the nipple, called the areola.

Despite the name, it is not related to Paget's disease of the bone, which is a metabolic bone disorder. The two conditions share only a name — and it's a distinction worth making, since most searches for "Paget's disease" return information about the bone condition.

The name and appearance of the condition can cause confusion in both directions. It is sometimes mistaken for eczema, which can delay diagnosis. And because most people with Paget's disease of the breast also have breast cancer in the breast tissue, a diagnosis of this condition is always followed by testing to look for cancer elsewhere in the breast.

What Does Paget's Disease of the Breast Look Like?

The hallmark sign is flaky or scaly skin on the nipple. The symptoms usually occur in one breast only and typically start at the nipple, possibly spreading to the areola and other areas of the breast. Because the skin changes resemble eczema, the condition is frequently mistaken for a benign rash at first.

Symptom	What It Looks or Feels Like
Flaky or scaly skin on the nipple	Dry, peeling skin that doesn't resolve with moisturizers
Crusty, oozing, or hardened skin	Skin that looks like eczema on the nipple, areola, or both
Itching	Persistent itch at the nipple that doesn't improve
Burning sensation	A burning feeling on or around the nipple
Nipple discharge	Straw-colored or bloody fluid from the nipple
Turned-in nipple	A nipple that becomes inverted or drawn inward
Breast lump	A palpable mass within the breast
Thickened skin	Skin on the breast that feels thicker than normal

Because symptoms overlap with eczema and other benign skin conditions, many people treat the rash at home for weeks before seeking care. The key difference is persistence — nipple changes that don't heal warrant a professional evaluation.

When should you see a doctor? Make an appointment with a healthcare professional if you have any symptoms that worry you — including scaly or crusty nipple skin, itching, burning, discharge, or a new lump. The source guidance is straightforward: make an appointment if you notice any change that concerns you.

Situation	What to Do
Scaly, crusty, or itchy nipple skin that doesn't improve	Schedule an appointment with a healthcare professional
Straw-colored or bloody nipple discharge	Schedule an appointment promptly
A new breast lump or thickened skin	Schedule an appointment promptly
A turned-in (inverted) nipple that's new	Schedule an appointment promptly
Any symptom that worries you	Don't wait — make an appointment

Why Does Paget's Disease of the Breast Happen?

The exact cause isn't clear, and experts aren't certain where this cancer begins. One theory is that it starts in the breast tissue, with cancer cells spreading through the milk ducts to the nipple. Another theory is that it starts directly in the nipple itself.

What is known is that, like all breast cancers, Paget's disease of the breast begins with DNA changes in breast cells. A cell's DNA holds the instructions telling it what to do — when to grow, when to multiply, and when to die. In cancer cells, DNA changes give different instructions: the cells grow and multiply quickly and keep living when healthy cells would die. In this condition, those abnormal cells build up in the nipple.

Who Is at Risk?

Paget's disease of the breast is a form of breast cancer, so it shares the same risk factors as other breast cancers. Having one or more risk factors does not mean you will develop the disease — most people with breast cancer have no known risk factors beyond age and sex.

Risk Factor	Details
Increasing age	Risk rises as you get older
Female sex assigned at birth	Women are much more likely than men to get breast cancer, but anyone with breast tissue can be affected
Family history	A parent, sibling, or child with breast cancer raises risk — especially if diagnosed young or involving multiple relatives; still, most people diagnosed have no family history
Personal history of breast cancer	Cancer in one breast increases the risk of cancer in the other
Certain breast conditions	Lobular carcinoma in situ (LCIS) and atypical hyperplasia of the breast raise risk
Early periods or late menopause	Periods before age 12 or menopause after age 55 increase risk
Dense breast tissue	Dense tissue makes cancer harder to detect on mammograms and itself raises risk
Alcohol use	Drinking alcohol increases breast cancer risk
Pregnancy history	First child after age 30, or never having been pregnant, increases risk
Inherited gene changes	BRCA1 and BRCA2 changes greatly increase risk, though not everyone with these changes develops cancer
Menopause hormone therapy	Combination estrogen and progesterone therapy raises risk; risk falls after stopping
Obesity	Higher body weight increases risk
Chest radiation	Radiation treatment to the chest as a child or young adult raises risk

What Can You Do to Lower Your Risk?

Breast cancer prevention steps apply to Paget's disease of the breast as well. These lifestyle measures can't guarantee prevention, but they may reduce overall breast cancer risk.

Prevention Step	What It Involves
Ask about screening	Discuss with your healthcare professional when to begin breast cancer screening and which tests are right for you
Know your breasts	Become familiar with how your breasts look and feel; report any new change, lump, or unusual finding right away
Limit alcohol	No more than one drink a day if you choose to drink; for prevention, there is no safe amount of alcohol
Exercise regularly	Aim for at least 30 minutes of exercise on most days
Limit hormone therapy	If using combination hormone therapy for menopause, use the lowest dose for the shortest time
Maintain a healthy weight	Work with your healthcare professional on healthy weight management

How Is Paget's Disease of the Breast Diagnosed?

Diagnosis combines a physical exam, imaging tests, and a biopsy. Because most people with Paget's disease of the breast have cancer within the breast tissue, imaging is used to look at the breast tissue for signs of cancer, and a tissue sample confirms the diagnosis.

Diagnostic Step	What Happens
Clinical breast exam	The healthcare professional looks for atypical skin or nipple changes, then feels the breasts, collarbones, and armpits for lumps
Mammogram	An X-ray of the breast tissue; a more detailed diagnostic mammogram is often used to look closely at both breasts
Breast ultrasound	Sound waves produce images that show whether a lump is a solid mass or a fluid-filled cyst, guiding next steps
Breast MRI	A magnetic field and radio waves create detailed pictures, usually with a dye injection, to find other areas of cancer in either breast
Biopsy	A sample of tissue is removed for laboratory testing — often a skin sample from the affected nipple; if imaging finds something concerning in breast tissue, a needle guided by imaging draws out tissue, and a small metal marker is usually left to help monitor the area

Pathologists — doctors who specialize in analyzing blood and body tissue — examine the samples to confirm whether cancer is present and determine its type.

How Is Paget's Disease of the Breast Treated?

Treatment is similar to other forms of breast cancer and usually involves surgery, often with additional therapies. Your treatment options depend on whether the cancer only affects the nipple or is also present in the breast tissue.

Treatment	What It Involves	When It's Used
Lumpectomy (breast-conserving surgery)	Removes the cancer, and for Paget's disease may include the nipple, areola, and other cancerous tissue; most people also receive radiation therapy afterward	When breast-conserving surgery is appropriate
Total (simple) mastectomy	Removes all breast tissue — lobules, ducts, fatty tissue, and some skin, including the nipple and areola	When more extensive removal is needed
Sentinel node biopsy	Removes a few lymph nodes near the cancer for testing; if none contain cancer, other lymph nodes typically don't need removal	To check whether cancer has spread
Axillary lymph node dissection	Removes many lymph nodes from the armpit	When imaging or sentinel biopsy shows spread to lymph nodes
Contralateral prophylactic mastectomy	Removes the other, healthy breast; an option for those at high risk due to family history or gene changes	Rarely — most people with cancer in one breast don't develop it in the other
Radiation therapy	High-energy beams target remaining cancer cells, usually after lumpectomy	Commonly after breast-conserving surgery
Chemotherapy	Medicines that kill rapidly dividing cancer cells	Depending on the cancer's characteristics
Hormone therapy	Medicines that block hormones that fuel certain breast cancers	When the cancer is hormone receptor-positive

Surgery carries general risks of pain, bleeding, and infection. Removing lymph nodes from the armpit adds a risk of lymphedema — swelling in the arm. Breast reconstruction, using an implant or your own tissue, is an optional choice after mastectomy; discussing a referral to a plastic surgeon before your cancer surgery gives you time to consider this option.

Additional treatments after surgery — radiation therapy, chemotherapy, or hormone therapy — may be recommended to lower the chances that the cancer returns. Whether you need them depends on the specifics of your cancer.

How Do You Cope After Diagnosis?

A breast cancer diagnosis can feel overwhelming at first, and it's stressful to cope with emotions while making important treatment decisions. In time, most people find ways to manage these feelings. In the meantime, four approaches can help.

Learning enough about your cancer helps you make decisions about your care — ask your healthcare team for details about your cancer and good sources of information on your treatment options. Talking with other breast cancer survivors through support groups, in person or online, can be helpful and encouraging. Finding someone to talk with about your feelings — a friend, family member, clergy member, or counselor — matters; your healthcare team can refer you to a mental health professional experienced with cancer. And keeping friends and family close builds a crucial support network; thinking ahead about what help you might want, such as listening or meal preparation, makes accepting offers easier.

How Do You Prepare for Your Appointment?

If symptoms worry you, make an appointment with a healthcare professional. If Paget's disease of the breast is suspected, you may be referred to a specialist — a doctor who treats breast conditions or a doctor who treats cancer.

Appointments can be short, so preparation helps. When booking, ask whether you need to do anything in advance, such as fasting before a specific test. Then make a list of your symptoms (including any that seem unrelated), key personal information such as major stresses and family medical history, all medicines, vitamins, and supplements with their doses, and the questions you want to ask. Bringing a family member or friend along can help you remember what you're told.

Questions to Ask Your Doctor	Questions the Doctor May Ask You
Do I have cancer?	What symptoms have you noticed?
Do I need more tests?	When did your symptoms start?
What are my treatment options?	Have the symptoms changed over time?
What are the potential risks of these options?	Have you had any breast conditions or biopsies?
Do any of the treatments cure my cancer?	What is your family medical history?
Can I have a copy of my pathology report?	What medicines, vitamins, or supplements do you take?
How much time can I take to consider my options?	Have you noticed any other changes in your body?
Are there printed materials or websites you recommend?	Have you ever had radiation treatment to your chest?
What would happen if I chose not to have treatment?	Is there a family history of breast cancer?

Conclusion

Paget's disease of the breast is a rare form of breast cancer that affects the nipple, producing scaly or crusty skin that is often mistaken for eczema. Most people with this condition also have breast cancer in the breast tissue, which is why evaluation always includes imaging and a biopsy. The good news: treatment follows well-established breast cancer pathways — surgery, radiation therapy, and medications — and many people are treated successfully.

If you've noticed persistent changes to your nipple — scaly or crusty skin, itching, burning, discharge, or a new lump — schedule an appointment with your healthcare professional for an evaluation. Early assessment leads to a clear diagnosis and a personalized treatment plan.

Frequently Asked Questions

Is Paget's disease of the breast the same as Paget's disease of the bone?

No. Despite sharing a name, they are completely different conditions. Paget's disease of the breast is a form of breast cancer affecting the nipple. Paget's disease of the bone is a metabolic bone disease in which the body replaces bone too quickly. They are not related.

What does Paget's disease of the breast look like?

It most often appears as flaky or scaly skin on the nipple, or crusty, oozing, or hardened skin that resembles eczema on the nipple or areola. It may also cause itching, burning, straw-colored or bloody nipple discharge, a turned-in nipple, a breast lump, or thickened breast skin. Symptoms usually affect one breast only.

Why is Paget's disease of the breast often mistaken for eczema?

The skin changes — scaly, crusty, itchy skin on the nipple or areola — closely resemble eczema. Because eczema is far more common, many people assume that's what they have and treat it at home, which can delay diagnosis. Persistent nipple skin changes that don't improve should always be evaluated by a healthcare professional.

Does having Paget's disease of the breast mean I have breast cancer?

Most people with Paget's disease of the breast also have breast cancer in the breast tissue, which is why diagnosis always includes imaging tests and a biopsy of both the nipple area and the breast. Only testing can confirm whether cancer is present elsewhere in the breast.

How is Paget's disease of the breast treated?

Treatment is similar to other breast cancers. Surgery is the main approach — either lumpectomy (often with radiation therapy) or total mastectomy — sometimes with lymph node testing or removal. Depending on the cancer, additional treatments such as radiation therapy, chemotherapy, or hormone therapy may be recommended to lower the chance of recurrence.

Can Paget's disease of the breast come back?

Additional treatments after surgery — radiation therapy, chemotherapy, or hormone therapy — are sometimes recommended specifically to lower the chances that the cancer returns. Whether you need them depends on the characteristics of your cancer. Your healthcare team can explain your individual recurrence risk and follow-up plan.

Is Paget's disease of the breast inherited?

The condition itself is not inherited, but some of its risk factors are. Inherited DNA changes such as BRCA1 and BRCA2 greatly increase breast cancer risk. A family history of breast cancer also raises risk, though most people diagnosed with breast cancer have no family history of the disease.

Can men get Paget's disease of the breast?

Yes. Anyone born with breast tissue can develop breast cancer, including Paget's disease of the breast. Women are much more likely than men to be affected, but the condition can occur in men.

References

1. Paget's disease of the breast — Symptoms & causes — Mayo Clinic, last reviewed September 12, 2025

2. Paget's disease of the breast — Diagnosis & treatment — Mayo Clinic, last reviewed September 12, 2025

This article is for general information only and is not a substitute for professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.