Significance of eczema in Paget's disease of the breast☆

Abstract The records of 108 patients with Paget's disease of the breast were reviewed. Patients were separated into two groups according to presence or absence of nipple eczema. Seventy-five patients were “nipple positive,” while the rest had “silent” or “negative” nipples. Axillary nodal involvement was found in 28% of patients with eczema and in 78% of patients belonging to the “silent” group (overall 41% ). The 5-yr survival was 70 and 47.2% in the “positive” and “silent” groups, respectively (overall 63.6% ). Patients with eczema were on the average, 8.7 yr older. The data corroborates our hypothesis that the presence or absence of an inflammatory response in the nipple to the Paget cells separates the patients into two prognostically different groups. Tumors eliciting an inflammatory response are associated with a protracted course, accounting for the superior prognosis in Paget's disease compared to breast cancer in general.