How do you diagnose Pagets desease?

[Cathy Lee]

My left breast has been burning and itching for almost a year now.  My radiologist and breast surgeon just looks at it and says no you don't have Pagets desease.  This doesn't give me the warm fuzzies.  How do you diagnose Pagets desease?  How is it biopsied?  If it isn't Pagets what else could it be?  The areola/nipple is not discolored or dimpled.  My last mammogram/ultrasound was 4 months ago.  Would appreciate your help.

[CCF-RN,MSN-rf]

Dear Cathy Lee:  Paget's disease of the breast usually presents as a scaling and itching of the nipple on one side.  In appearance, it looks like eczema.  If this doesn't go away, a skin biopsy of the nipple should be done.  A mammogram should also be done, since some types of paget's disease are associated with DCIS or invasive cancer.

[surgeon]

paget's disease, by definition, involves a visible rash on the nipple. It is diagnosed by doing a biopsy of the area involved in the rash. Itching and burning can be caused by lots of things, but cancer is pretty low on the list, especially if physical exam and mammogram are ok.

[Cathy Lee]

I go to my OBGYN next week.  What tests should they do?  What other things could it be?  Thank you.