A patient has Paget's disease of the nipple without an underlying mass on imaging. The correct surgical management is:

• A Total mastectomy with ALND regardless of imaging findings
• B Simple mastectomy alone without axillary assessment
• C Nipple excision with skin-sparing mastectomy and immediate reconstruction
• D Central quadrant excision (including nipple-areola complex) with SLNB, followed by whole-breast irradiation if margins clear ✓

Explanation

When Paget's disease of the nipple occurs without an underlying mass (accounting for ~50% of cases), breast conservation via central quadrant excision including the nipple-areola complex is acceptable, combined with SLNB for axillary staging, followed by whole-breast radiation. This approach offers equivalent local control to mastectomy in carefully selected cases. Total mastectomy is indicated when there is an associated mass, multicentric disease, or when the patient prefers it. ALND is only added if sentinel node is positive.

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.