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Paget’s Disease of the Nipple

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Paget's disease is a rare cancer of the nipple and areola, the darker skin around the nipple. It affects both men and women.

The symptoms include irritation around the nipple, flaky or crusty skin and nipple discharge. The majority of people with Paget's disease also have another type of cancer, so it's important to see your doctor if you notice these signs.

Why Choose Sylvester Comprehensive Cancer Center?

Renowned Braman Family Breast Cancer Institute at Sylvester. We offer treatments customized to your individual needs at one of the nation's best breast cancer diagnosis and care programs.

Breast Imaging Center of Excellence designation by the American College of Radiology. Thanks to imaging excellence, you receive a more precise diagnosis, which then guides a more effective treatment plan.

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Treatments

  • Surgery

    The first line of treatment for Paget's disease is surgery. The type of surgery you need will depend on how much of your breast is affected. Your surgeon will remove the nipple and areola, as well as any other cancer within your breast. In some instances, breast-conserving surgery — which removes only diseased tissue and leaves healthy breast tissue intact — can be an option.

  • Breast-Conserving Surgery

    Usually, this type of surgery involves removing the nipple and areola removal and a lumpectomy to remove the cancer from the underlying breast tissue. Surgeons remove the cancerous area and a small margin of healthy tissue around it to be sure no cancer cells are left behind. Your doctor will discuss your options and help you decide what's right for you.

  • Mastectomy

    If you have an invasive cancer in addition to Paget's disease, your doctor may recommend removing your entire breast, called a mastectomy, to make sure all cancer cells are removed. If you decide you want reconstructive surgery to restore your breast, you can do so as part of your initial surgery or wait until later to have surgery.

    The type of mastectomy you have — total mastectomy or modified radical mastectomy — depends on how advanced the cancer is.

  • Total or Simple Mastectomy

    In this surgery, your surgeon removes your entire breast, but leaves your underarm lymph nodes intact.

  • Modified Radical Mastectomy

    With a modified radical mastectomy, your surgeon removes the nipple, areola and all of the breast tissue without removing the underlying muscle.

  • Sentinel Lymph Node Biopsy

    Doctors use this minor surgery to determine if cancer has spread beyond a primary tumor into your lymphatic system. A sentinel lymph node is the first place cancer cells may move to when they begin to spread. During the biopsy, your doctor injects a special dye (tracer) to locate the nodes and remove them to look for cancer cells. If they're free of cancer, it means it's unlikely that cancer has spread and it's not necessary to remove more lymph nodes.

    Sylvester offers a novel treatment that prevents taking more lymph nodes, even if the sentinel node is suspicious. Before surgery, an ultrasound scan of the armpit can highlight which lymph nodes are involved (they will appear enlarged or swollen). When chemotherapy is used before surgery (neoadjuvant chemotherapy), it can convert a previously positive lymph node to negative when biopsied, which means more lymph nodes don't need to be removed.

  • Radiation Therapy

    If you have breast-conserving surgery, rather than a mastectomy, you will also need to have radiation therapy to destroy any cancer cells left behind after surgery. If Paget's disease is confined to your nipple and areola and no cancer cells were found in your lymph nodes, you won't need any additional treatment after radiation therapy.

  • Chemotherapy

    Chemotherapy is cancer-fighting medicine that's administered intravenously or by a pill. Chemotherapy also might be recommended before surgery, called neoadjuvant chemotherapy, to help reduce the size of the tumor and improve surgical results. Often, more than one chemotherapy medicines are used at the same time or one after the other to destroy different kinds of cancer cells that come from the same breast cancer.

    Locations: If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables and Deerfield Beach locations.

  • Cold Cap Therapy to Minimize Hair Loss

    Sylvester offers FDA-cleared cold cap therapy to reduce hair loss during chemotherapy. This therapy works by cooling the scalp during treatment.

  • Targeted Therapy

    Targeted therapies are treatments designed to attack the molecular changes that make the cancer cells grow and spread. The FDA has approved several targeted therapies.

    Herceptin, a common type of targeted therapy, treats HER2-positive breast cancers. In these breast cancer, the cancer cells have a gene mutation that creates too much HER2 protein, which stimulates cancer cell growth. Herceptin targets and blocks the receptors, so the signals to grow and spread can't be delivered. Herceptin also marks the cancer cells so the immune system can destroy them.

  • Hormone Therapy

    After you have surgery, and possibly radiation therapy, you may need to have one or more additional therapies, such as chemotherapy, targeted therapy or hormone therapy. Since most people with Paget's disease of the nipple also have invasive breast cancer, your treatment will be based on the type and stage of cancer you have.

Accepted Insurances

Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

  • Aetna WC
  • Aetna Affiliates/Signature Adm (ASA)
  • Aetna Behavioral Health
  • Aetna Elect Choice (EPO)
  • Aetna Florida Healthy Kids
  • Aetna HMO
  • Aetna Medicaid HMO
  • Aetna Medicare HMO
  • Aetna Medicare PPO
  • Aetna POS
  • Aetna PPO
  • Aetna UM Employee HMO 1
  • Aetna UM Employee HMO 2
  • Aetna UM Employee POS HRA
  • Aetna/Coventry Institutes of Excellence (IOE)
  • Amerigroup Florida Healthy Kids
  • Amerigroup Medicaid HMO
  • Argus Vision
  • AvMed Choice
  • AvMed HMO/POS
  • AvMed MDC and JHS Groups
  • AvMed Medicare HMO
  • AXIS
  • BCBS Blue Options Network Blue PPO
  • BCBS BlueCare HealthOptions HMO
  • BCBS BlueChoice PPC/PPO
  • BCBS Miami Dade Blue PPO Limited Benefits Plan
  • BCBS of Florida (All products except "SELECT" Plans)
  • BCBS of Florida (Commercial plans exclude HIX Select)
  • BCBS Traditional PHS/PPO
  • Beacon Health (ValueOption)
  • Beech Street PPO
  • Broward Health Medical Center
  • CarePlus Medicare HMO
  • Catholic Hospice
  • CCP/CMS Title XIX (Medicaid Enrolled in South Florida)
  • CCP/CMS Title XXI (Non Medicaid Enrolled in South Florida)
  • CCP/MMA (Broward County residents)
  • Charlotte County Sheriffs Office PPO
  • Cigna Affiliates
  • Cigna Behavioral Health
  • Cigna Dental HMO/PPO
  • Cigna EPO
  • Cigna HMO
  • Cigna Life Source (Intracorp is part of Cigna Lifesource)
  • Cigna MDCPS Jackson Sr. High
  • Cigna POS
  • Cigna PPO
  • Cigna Shared Administration
  • Clear Health Alliance SNP Medicaid HMO
  • Concordia Behavioral Health
  • CorVel WC
  • Coventry First Health WC
  • Coventry Health Care of Florida (HIP) HMO/POS
  • Coventry Health Care of Florida (HIP) PPO
  • Coventry Health Plan of Florida (Foundation) HMO
  • Coventry Health Plan of Florida (Foundation) POS
  • Coventry National PPO
  • Coventry Summit Medicare HMO
  • Coventry Vista Medicare HMO
  • Coventry First Health PPO
  • Delta Dental PPO
  • DentaQuest (ADI)
  • DIKLA
  • Dimension WC
  • Dimension Plus PPO
  • EHN PPO
  • EQUIAN (Health Systems International)
  • Europe Assistance/Global Corporate Solutions (Care Management Network)
  • eyeQuest
  • FCCI WC
  • Florida Healthcare Plan (Affiliate of BCBSFL)
  • Florida PACE (FPC)
  • Freedom Health Medicaid HMO
  • Freedom Health Medicare HMO
  • Gallagher Bassett WC (MDCPS & FCSRMC)
  • Global Excel Mgt PPO
  • Great West (Cigna) HMO/POS
  • Guardian Life PPO
  • HAA Preferred Partners
  • Health First Health HMO/POS
  • Health First Health Medicare HMO
  • Health First Health PPO
  • Health Net Veterans Choice HMO
  • Heritage Summit Healthcare WC
  • Humana Behavioral Health (LifeSynch)
  • Humana Dental/CompBenefits/OHS
  • Humana EPO
  • Humana HMO
  • Humana Medicaid HMO
  • Humana Medicare HMO
  • Humana National Transplant
  • Humana PPO
  • Humana Premier
  • iCare Health Solutions
  • Interlink Health Services
  • International Kids Fund (IKF)
  • League Medical Concepts Federal Inmates
  • Life Trac
  • Magellan Behavioral Health
  • Magellan Complete Care SNP Medicaid HMO
  • MDAbroad
  • Medica Medicare HMO
  • Medical Development In't (MDI)-Federal Inmates
  • Medicus
  • Metlife Dental PPO
  • MHNet Behavioral Network (MHNet)
  • Molina
  • Molina Market Place
  • Molina Medicaid HMO
  • Molina Medicare HMO
  • Morgan White International
  • MultiPlan PPO
  • Naphcare (Federal Prisoners)
  • National Healthcare Solutions Inc.
  • Neighborhood HealthPlan HMO/POS
  • Neighborhood HealthPlan PPO
  • North Broward Hospital District PPO
  • Olympus Managed Healthcare
  • Optum
  • Positive Healthcare SNP Medicaid HMO
  • Positive Healthcare SNP Medicare HMO
  • Prestige Health Choice Medicaid HMO
  • Prime Health Services WC
  • Quality Health Management
  • Religious Order of Jehovah's Witnesses PPO
  • Rockport Healthcare Group WC
  • Royal Caribbean Cruises PPO
  • Sanus Health Corporation
  • Seasons Hospice
  • Simply Healthcare Medicaid HMO
  • Solstice Dental HMO/PPO
  • Start Healthcare Network
  • Sunshine
  • Sunshine AMBETTER
  • Sunshine Healthy Kids HMO
  • Sunshine Medicaid HMO
  • Sunshine Medicare HMO
  • Tricare South Prime HMO
  • Tricare South Standard PPO
  • United Behavioral Health (UBH)
  • UnitedHealthcare Affiliates
  • UnitedHealthcare Healthy Kids HMO
  • UnitedHealthcare HMO/POS
  • UnitedHealthcare Medicaid HMO
  • UnitedHealthcare Medicare Nursing Home Plan
  • UnitedHealthcare PPO
  • University of Miami Athletic Dept PPO
  • VUMI
  • Wellcare/Staywell Healthy Kids HMO
  • Wellcare/Staywell Medicaid HMO
  • Wexford Health State Inmates
  • Worldwide Managed Care