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Pigmented Mammary Paget Disease Mimicking Superficial Spreading Melanoma in an Elderly African-American Female

Background Pigmented mammary Paget disease (PMPD) is a rare disease that may mimic cutaneous melanoma both in clinical presentation and on histology. Objective The goal of this study was to discuss the clinical and histologic similarities between PMPD and cutaneous melanoma and how to differentiate between the two diseases. Methods We describe an African-American patient with PMPD who was thought to have cutaneous melanoma on presentation. We describe the similarities of PMPD to cutaneous melanoma both clinically and on histology and discuss the methods of differentiation. Results Clinical examination revealed a large pigmented patch of the left breast that appeared asymmetrical with irregular borders with a highly variable color pattern throughout. Histologic evaluation showed characteristics shared between PMPD and cutaneous melanoma. Immunohistochemical staining was needed for differentiation. Conclusion PMPD is a rare disease and is similar in clinical presentation and on histology to cutaneous melanoma. Immunohistochemical staining must be used to differentiate between the two diseases.