Try it
General Surgery · Breast and endocrine surgery: Paget disease of the nipple
Sample itemA woman has a unilateral scaly, eczematous nipple lesion not responding to topical steroids for 3 months. What is the next step?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Biopsy of the nipple and breast imaging for underlying carcinoma
Paget disease of the nipple is intraepidermal spread of malignant cells from underlying DCIS or invasive carcinoma in most cases. Punch or wedge biopsy shows large vacuolated Paget cells and imaging identifies the underlying lesion.
Option by option
A. Biopsy of the nipple and breast imaging for underlying carcinoma (correct)
Correct. Biopsy and imaging are required.
B. Antifungal cream
Antifungals do not treat Paget disease.
C. Observation for 1 year
Delay risks progression.
D. Reassure and continue steroids
Persistent eczema needs tissue diagnosis.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
More General Surgery questions
- HerniaA groin hernia that passes medial to the inferior epigastric vessels through Hesselbach'…
- BurnsA 70 kg adult has burns over 40% of the body surface. By the Parkland formula, what tota…
- HerniaA hernia that enters the inguinal canal through the deep ring, lateral to the inferior e…
- Intestinal obstructionWhat is the commonest cause of small bowel obstruction in adults?