Im terrified this might be Paget's disease..please help..

[momtotwinsplus1]

Hello and thanks in advance for your time. Im really afraid I might have Paget's disease of the breast and I need some advice. I am 37 y/o with 3 young children. After the birth of my twins and subsequent nursing for 3 months, my right nipple inverted (that was 5 years ago). All my life I have had severe eczema (as in cracking,oozing and sometimes bleeding)skin. As long as I can remember Ive had itchy nipples. Unfortunately within the last year my right nipple has become more itchy,lately within the last 5 months when I itch it, the skin appears to crack, then weep,then gets scaly, sometimes after being inverted, it will have a yellowish crust around it. Then is goes away,without treatment, but always comes back. Now, that I compare it to my other nipple it seems quite different, the glands seem larger,and the cleft is deeper and wider, and when the nipple is really erect there is a yellow ring around the nipple, almost like blanching. No spots of eczema on the areola.  No definite sores, but general flakiness.I had a mammogram 3 years ago, that was fine, and my last manual (done by gyn) was a year ago, also fine. Recently, I did have 2 patches of impetigo, (thanks to kindergarten!) underneath my breasts. My left breast does have some flakiness from itching, but nothing at all like the right one.
How worried should I be that this might be paget's, and should I insist on a biopsy? Please advise, Im absolutely sick to my stomach over this.Thank you.

[CCF-RN,MSN-rf]

Dear momtotwinsplus1:  Paget's disease is an uncommon form of breast cancer that usually presents as a scaling and itching on one nipple that does not go away.  Other skin conditions, such as eczema, are much more common.  If you are concerned, have your doctor take a look.  

[momtotwinsplus1]

P.S. Saw gyn today, he said nipple looked ok, but was concerned about it having edema, and told me to use cortizone for 2 weeks, and if it doesnt clear go to dermatologist, and if he cant fix it, then we'll consider mammogram. Ive heard horror stories about dr's saying just use cortizone, and missing the diagnosis! What should I do?

[mojo29]

You are obviously very worried about this and for good reason.  This is YOUR body and YOUR life.  For your own peace of mind, if for no other reason, you should insist on a mammogram to rule out cancer, rather than waiting to do that as a last resort.  If your doctor disagrees, too bad...It should be your call to make.  Better safe than sorry! Good luck!

mojo29

[surgeon]

a mammogram could easily miss Paget's disease, because often the cancer cells are within the ducts, and don't form a visible mass. The way to diagnose it, if observation raises the possibility, is a small and simple biopsy of the affected skin, which is a quick office procedure.