Paget's disease of the nipple occurring after wide local excision and radiotherapy for carcinoma of the breast.

Between 1979 and 1985, 356 cases of Stage I or II breast carcinomas have been treated at Westminster Hospital with breast conservation. Of these patients, 338 underwent local excision and radiotherapy and there have been 38 local recurrences. Three of these have been as Paget's disease of the nipple occurring 16, 8 and 5 months following radiotherapy. In each case the nipple appearances were attributed to postradiotherapy changes; the true diagnosis was not made for an average of 19 months. The increasing use of conservative breast management for early breast tumours permits the appearance of Paget's disease as a significant proportion of local recurrences. Previously this has been considered to be a rare event. We recommend that Paget's disease of the nipple should be suspected early following radiotherapy in the presence of any nipple changes.