32 patients with clinical and biopsy proven Paget's disease of the nip
ple were treated over a 25-year period at three Bristol hospitals. Fou
r additional cases which had Paget's change found histologically are i
ncluded. 16 patients had a palpable mass in addition to nipple changes
. Definitive treatment included; a modified radical mastectomy (18), s
imple mastectomy (11), wedge excision (4) wide local excision and radi
otherapy (2) and tamoxifen alone (1). An associated invasive palpable
tumour proved the most significant prognostic factor being present in
7 of 8 patients demonstrating recurrence within 5 years. Mammography r
evealed a high false negative rate (8 of 17) but was the single positi
ve investigation in one patient. Scrape smear cytology of the nipple s
kin eruption was positive in the 6 cases examined and may be the prefe
rred choice of diagnostic technique.