Skin tumours: mammary Paget disease: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Dermatology · Skin tumours: mammary Paget disease

Sample item

A 58-year-old woman has a unilateral, scaly, eczematous patch of the nipple and areola that has not responded to topical steroids over several months. Which step is most appropriate?

AReassurance, as it is nipple eczemaBPunch or wedge biopsy of the nipple lesion with breast imagingCContinue a potent topical steroid for six more monthsDOral antifungal therapy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Punch or wedge biopsy of the nipple lesion with breast imaging

Unilateral nipple eczema that does not heal should raise suspicion of Paget disease of the breast, which is almost always linked to underlying ductal carcinoma in situ or invasive breast cancer. Biopsy shows large pale Paget cells in the epidermis, and breast imaging is required.

Option by option

A. Reassurance, as it is nipple eczema
Reassurance is unsafe for a persistent unilateral nipple lesion.
B. Punch or wedge biopsy of the nipple lesion with breast imaging (correct)
Correct. Biopsy and breast imaging are needed to find the underlying carcinoma.
C. Continue a potent topical steroid for six more months
More steroid delays the diagnosis of an underlying malignancy.
D. Oral antifungal therapy
An antifungal does not treat Paget disease and delays 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.

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is B, Punch or wedge biopsy of the nipple lesion with breast imaging. Unilateral nipple eczema that does not heal should raise suspicion of Paget disease of the breast, which is almost always linked to underlying ductal carcinoma in situ or invasive breast cancer.

Why is "Reassurance, as it is nipple eczema" not the answer?

Reassurance is unsafe for a persistent unilateral nipple lesion.

Why is "Continue a potent topical steroid for six more months" not the answer?

More steroid delays the diagnosis of an underlying malignancy.

Why is "Oral antifungal therapy" not the answer?

An antifungal does not treat Paget disease and delays diagnosis.

What concept does this question test?

It tests Skin tumours: mammary Paget disease in Dermatology. Biopsy shows large pale Paget cells in the epidermis, and breast imaging is required.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Skin tumours: mammary Paget disease?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.