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Greetings. I Have Been Treated By A Dermatologist For What

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Posted on Sun, 4 Oct 2020
Question: Greetings. I have been treated by a dermatologist for what was considered seborrheic dermatitis and keratosis on my right nipple (which becomes somewhat sensitive or itchy from time to time, and peels some dry skin, for which I use a cream). However, after a year or so the doctor last week performed a biopsy, which resulted in a finding of Paget's Disease. The report provides no grading, and the appearance has not really changed over time. Since it means there are cancerous cells underneath the nipple, is the only alternative to this (even without a grading or stage) the removal of the nipple area? I have no other symptoms and have scheduled a consultation with a surgeon for next week. Thank you.
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Follow up: Dr. Olgeta Xhufka (0 minute later)
Greetings. I have been treated by a dermatologist for what was considered seborrheic dermatitis and keratosis on my right nipple (which becomes somewhat sensitive or itchy from time to time, and peels some dry skin, for which I use a cream). However, after a year or so the doctor last week performed a biopsy, which resulted in a finding of Paget's Disease. The report provides no grading, and the appearance has not really changed over time. Since it means there are cancerous cells underneath the nipple, is the only alternative to this (even without a grading or stage) the removal of the nipple area? I have no other symptoms and have scheduled a consultation with a surgeon for next week. Thank you.
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Follow up: Dr. Olgeta Xhufka (8 minutes later)
What would be good questions to ask the surgeon when I meet with him next week? I am sure he will do a scan, which I can report back to you about. But will this situation require radiation if surgery is performed? I guess I am pretty apprehensive. Thank you.
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Follow up: Dr. Olgeta Xhufka (0 minute later)
What would be good questions to ask the surgeon when I meet with him next week? I am sure he will do a scan, which I can report back to you about. But will this situation require radiation if surgery is performed? I guess I am pretty apprehensive. Thank you.
doctor
Answered by Dr. Olgeta Xhufka (1 hour later)
Brief Answer:
Surgery and radiation are needed.

Detailed Answer:
Hello dear, welcome to Ask a doctor's service.
I read your query and here is my advice.

I am sorry to hear this from you.
If the biopsy showed Paget disease the treatment can be total mastectomy or partial mastectomy followed by radiation therapy.
You can ask your surgeon what type of surgery will you have?
Will you have radiography or not and how much will it last?
I also see the result of tests you uploaded.
You are having two thyroid nodules and elevated T4 levels. You may need treatment for it but an endocrinologist opinion is needed.
Also you are having high LDL levels and low HDL.
Hope I have answered the question.
Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Olgeta Xhufka (0 minute later)
Brief Answer:
Surgery and radiation are needed.

Detailed Answer:
Hello dear, welcome to Ask a doctor's service.
I read your query and here is my advice.

I am sorry to hear this from you.
If the biopsy showed Paget disease the treatment can be total mastectomy or partial mastectomy followed by radiation therapy.
You can ask your surgeon what type of surgery will you have?
Will you have radiography or not and how much will it last?
I also see the result of tests you uploaded.
You are having two thyroid nodules and elevated T4 levels. You may need treatment for it but an endocrinologist opinion is needed.
Also you are having high LDL levels and low HDL.
Hope I have answered the question.
Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Olgeta Xhufka (1 hour later)
I am very sorry. Somehow there was a mistake in what I uploaded, so I will try to upload again, including the photograph. Doesn't the degree of cancer cells determine whether just the nipple has to be removed or also some flesh? In any case I will upload the files again.
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Follow up: Dr. Olgeta Xhufka (0 minute later)
I am very sorry. Somehow there was a mistake in what I uploaded, so I will try to upload again, including the photograph. Doesn't the degree of cancer cells determine whether just the nipple has to be removed or also some flesh? In any case I will upload the files again.
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Follow up: Dr. Olgeta Xhufka (3 minutes later)
I see the correct files were uploaded with my question the first time twice! I don't know how it happened that you did not see them, but some blood work files. Thank you.
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Follow up: Dr. Olgeta Xhufka (0 minute later)
I see the correct files were uploaded with my question the first time twice! I don't know how it happened that you did not see them, but some blood work files. Thank you.
doctor
Answered by Dr. Olgeta Xhufka (55 minutes later)
Brief Answer:
Scan is also needed to determine the kind of surgery.

Detailed Answer:
Hello dear and thank you for asking again.
I see the photos you attached now the photo of the nipple and of the biopsy results which show that it is Paget disease.
The treatment depends on the results of the scan and biopsy.
Despite the degree or type of cancer cells there are other things important for treatment like the infiltration on cancer cells on breast , measurements of tumor and lymph nodes present , axillary lymph nodes and in other regions.
Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Olgeta Xhufka (0 minute later)
Brief Answer:
Scan is also needed to determine the kind of surgery.

Detailed Answer:
Hello dear and thank you for asking again.
I see the photos you attached now the photo of the nipple and of the biopsy results which show that it is Paget disease.
The treatment depends on the results of the scan and biopsy.
Despite the degree or type of cancer cells there are other things important for treatment like the infiltration on cancer cells on breast , measurements of tumor and lymph nodes present , axillary lymph nodes and in other regions.
Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Olgeta Xhufka (2 hours later)
The regular dermatologist felt my lymph nodes and said they felt normal. No lymphs in the breast either. I have had the discoloration for a couple of years. Anyway, you mean I have to do a cat scan to see how many cells there are? Does the nipple discoloration indicate how many cells might exist in the breast?
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Follow up: Dr. Olgeta Xhufka (0 minute later)
The regular dermatologist felt my lymph nodes and said they felt normal. No lymphs in the breast either. I have had the discoloration for a couple of years. Anyway, you mean I have to do a cat scan to see how many cells there are? Does the nipple discoloration indicate how many cells might exist in the breast?
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Follow up: Dr. Olgeta Xhufka (1 minute later)
I meant no lumps in the breast....
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Follow up: Dr. Olgeta Xhufka (0 minute later)
I meant no lumps in the breast....
doctor
Answered by Dr. Olgeta Xhufka (8 hours later)
Brief Answer:
Ct scan will evaluate the lymph nodes.

Detailed Answer:
Hello dear and thank you for asking again.
The cat scan doesn't evaluate how many cells are.
The cat scan will evaluate the dimensions of the Paget and also if there are any lymph nodes.
The ct scan is needed to evaluate the decision about surgery.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Olgeta Xhufka (0 minute later)
Brief Answer:
Ct scan will evaluate the lymph nodes.

Detailed Answer:
Hello dear and thank you for asking again.
The cat scan doesn't evaluate how many cells are.
The cat scan will evaluate the dimensions of the Paget and also if there are any lymph nodes.
The ct scan is needed to evaluate the decision about surgery.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
Answered by
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Dr. Olgeta Xhufka

General & Family Physician

Practicing since :2011

Answered : 10168 Questions

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Greetings. I Have Been Treated By A Dermatologist For What

Greetings. I have been treated by a dermatologist for what was considered seborrheic dermatitis and keratosis on my right nipple (which becomes somewhat sensitive or itchy from time to time, and peels some dry skin, for which I use a cream). However, after a year or so the doctor last week performed a biopsy, which resulted in a finding of Paget's Disease. The report provides no grading, and the appearance has not really changed over time. Since it means there are cancerous cells underneath the nipple, is the only alternative to this (even without a grading or stage) the removal of the nipple area? I have no other symptoms and have scheduled a consultation with a surgeon for next week. Thank you.