LAUSR

A 62 year old Chinese woman presented with a painless pigmented lesion on the right nipple-areola complex (NAC). The lesion began as a small asymptomatic black spot on the base of nipple five years ago and had gradually increased in size. Physical examination revealed an irregular pigmented macular lesion, about 4×3 cm, on the right NAC (fig 1). The borders of the lesion were darkly pigmented, with scales on the surface. The lesion was painless and moveable from the underlying structures. The woman denied any discharge, pruritus, or history of carcinogen exposure; and her family history was unremarkable. Fig 1 Skin lesion on the right nipple-areola complex On palpation, no breast masses or lymphadenopathy were found. ### 1. What are the differential diagnoses for a pigmented skin lesion with colour variegation on the NAC? Differential diagnoses include: eczematous breast conditions, seborrheic keratosis, pigmented Bowen’s disease, pigmented mammary Paget’s disease, and superficial spreading melanoma. In contact dermatitis and eczema, hyperpigmentation appears in the chronic phase.1 In seborrheic keratosis, hyperkeratosis and horn cysts are present. In pigmented mammary Paget’s disease, the lesion occurs on the surrounding skin …