Bowen’s disease of the nipple: a case report

: Squamous cell carcinoma in situ (SCCIS), also known as Bowen’s disease, commonly develops in skin on areas exposed to sunlight, such as head and neck, trunk, and the extremities. Here we report our experience with this rare disease and even rarer its presentation on the breast nipple. The patient is a 73-year-old female who presented to the Breast Clinic with a chief complaint of scaling, crusting, itching and irritation of her left nipple. Her most recent mammogram was reported as BIRADS category 2, benign. Following complete work-up a definitive diagnosis of SCCIS was confirmed by punch biopsy. The patient was treated by complete excision of the nipple and pathology revealed focal SCCIS with no evidence of pagetoid cells or invasive neoplasm. This report will discuss the clinical presentation, diagnosis, pathology, management, and prognosis of this rare nipple lesion. One should be cautious not to confuse this with other intraepithelial lesions requiring a very different approach to therapy, such as the use of topical antibacterial, antifungal, or steroidal agents. In conclusion, we stress the importance of differentiating this disease from Paget’s disease which may have a very similar appearance, but requires a more extensive investigation for associated parenchymal disease. Furthermore, Bowen’s disease can be managed with wide nipple excision to completely remove the lesion with uninvolved margins. There is no concern for parenchymal extension.