Hello doctor, I have Li Fraumeni Syndrome which greatly increases my chances of cancer. I have regular various annual screenings. I had a breast MRI three months back and the report (which I do not have) stated that the contrast seemed to 'pool' in one place. The doctor said he was not overly concerned but to repeat MRI in six months rather than in usual 12 months. Three days ago, I woke in the night with intense nipple pain in the left breast. It has not really subsided since. I have found a small scab on my areola under the nipple and my left nipple appears much larger and a bit darker than my right. I do not know if I am just noticing the difference now or if it has always been like that. My question is can a small scab form on the areola and not the nipple, but the nipple is swollen with Paget's disease? Maybe I just scratched it without knowing but would my nipple be swollen from a scratch as well even though scratch is not touching nipple? Thanks for your time.
Hello. Paget's disease mostly involves nipple and later spread to areola, but it can also involve areola only. It is possible that areola is involved and the nipple is swollen. Many cases of Paget's disease do have lump below the nipple or some cancerous lesion. Is this lesion progressing, stable or regressing, is there any itching, burning also with pain, does it appear like eczema or just reddish scab? Regarding your scratch possibility, I do not really think that some unnoticed scratch has caused has lesion, scab and nipple swelling which is persistent from three days. So, considering you have a predisposing condition and unexplained lesion, I think it should be evaluated on priority. You also palpate your both breast especially below the nipple for any lump. So I think you should get this examined, and also biopsied. Hope this helps you and get back if you have any other doubts or information to share. All the best. For more information consult an internal medicine physician online -->