A 60-year-old woman is diagnosed with Paget's disease of the nipple. Core biopsy of the retroareolar region shows DCIS with no palpable mass and negative MRI for invasive component. The most appropriate surgical option that preserves breast conservation is:
- A Central excision (removal of nipple-areola complex and retroareolar tissue) with whole breast radiation ✓
- B Simple mastectomy with sentinel node biopsy
- C Wide local excision sparing the nipple
- D Nipple-sparing mastectomy with immediate reconstruction
Explanation
Paget's disease associated with only DCIS (no invasive component) can be managed with breast conservation surgery. Central excision involves removal of the nipple-areola complex and retroareolar tissue with adequate margins, followed by whole breast irradiation — this approach has recurrence rates comparable to mastectomy when combined with radiation. Simple mastectomy is appropriate when BCS margins are inadequate or patient preference. Nipple-sparing mastectomy is contraindicated as the primary tumor involves the nipple. Sparing the nipple would leave disease behind.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.