Hi Most nipple rashes are simply a minor skin infection or a reaction to some irritant. A nipple rash that does not get better with topical treatments requires biopsy. This is done by anesthetizing the nipple and areola with local anesthetics and then taking a small sample of the affected skin (punch biopsy). After Paget’s disease is diagnosed by nipple skin biopsy, the evaluation will continue with mammography and possibly ultrasound or MRI to look for an underlying breast cancer. Because of the skilled expertise of our pathologists who specialize in breast cancer, we are able to accurately diagnose Paget’s disease. As with any cancer, early detection and diagnosis results in better outcomes for the patient. Despite the rarity of this type of breast cancer, the specialists at our Breast Center are experienced in managing the evaluation and treatment of this disease. If the breast cancer is limited to Paget’s disease, treatment includes the surgical removal of the nipple and areola, as well as a margin of healthy tissue around the areola. A central breast resection will generally preserve the shape and size of the breast and the nipple can be reconstructed later. In some cases, mastectomy may be recommended. Your physician may recommend a combination of any of the following: Central breast resection – this involves removal of the nipple and areola along with a sufficient amount of tissue underneath to ensure removal of the cancer cells. It is usually followed by radiation. Mastectomy Radiation therapy Hormonal therapy If the biopsy shows DCIS, stage 0 cancer and no invasive cancer, the prognosis is excellent.