History:

 A 63-year-old lady complained of a more  than one-year history of persistent, moderately pruritic, unilateral, slightly infiltrative red plaque involved the left nipple and surrounding areolar region. The patient claimed partial improvement on topical steroid treatment which had been prescribed from time to time. O/E many left axillary lymph nodes were palpable. Skin biopsy confirmed the diagnosis of Paget's disease of the breast and immunohistochemical assessment revealed positive CEA, EMA and negative S-100 protein. The patient had been referred to surgery.