Consider the following clinical note: "A 55-year-old lady, a college professor, presented to us with a history of persistent itching, erythema, oozing and crusting over the nipple, areola and periareolar region on the left breast of more than 6 months duration. The lesions had been localized to the nipple and immediate periareolar region initially but had started extending recently. She had been using various topical medications for the same including steroids of varying potency. The patient had good response to topical steroids initially but on further use the lesion appeared to be getting worse. The patient had no other significant co-morbidity and was in otherwise good health. On examination we found an ill-defined area of scaling, erythema and minimal crusting over the over the nipple, areola and peri-areolar region on the left breast. There was minimal induration over the nipple and immediate peri-areolar area and no significant tenderness or bleeding on touch. Patient had no significant lymphadenopathy. The unilateral nature of the central lesions and the apparent lack of response to topical steroids made us consider a possibility of mammary Paget's disease, for which the patient was evaluated. Routine blood and urine investigation were within normal limits. Potassium hydroxide smears and cytology findings were normal. Mammography showed no evidence of any micro calcification or significant breast tissue involvement suggestive of malignancy. A skin biopsy was taken form two sites and both the specimens sh