How do you manage Paget's disease of the nipple?

I think of Paget's as a special form of DCIS +/- invasive cancer. We do not routinely perform breast MRI here for this diagnosis (but I can see the utility of this if there is any uncertainty about the extent of the lesion). We consider the local therapy principles to be similar to other early-stage...

This requires imaging including a breast MRI. If the patient has other sites of disease in another quadrant which can be seen in Paget's disease, then I recommend mastectomy. If imaging is negative, then I recommend central lumpectomy (which usually shows DCIS in retroareolar breast tissue) and adju...