Surgical management of Paget’s disease of the breast: an update on treatment strategies

Paget’s disease of the breast, or mammary Paget’s disease (MPD), is a rare and often misdiagnosed form of breast cancer, typically presenting as eczematous or ulcerative lesions on the nipple-areola complex. Occurring in about 1-3% of all breast malignancies, MPD is frequently associated with underlying ductal carcinoma in situ (DCIS) or invasive carcinoma, necessitating a high degree of clinical vigilance for early diagnosis and treatment. Traditionally, surgical excision has been the cornerstone of treatment, with mastectomy serving as the standard approach. However, advances in imaging and surgical techniques have introduced breast-conserving surgery (BCS) and oncoplastic methods as viable alternatives, particularly for cases with localized disease. This review explores current surgical strategies for MPD, discussing indications, outcomes, and aesthetic considerations for mastectomy and BCS, as well as the role of sentinel lymph node biopsy (SLNB) in cases involving invasive carcinoma. In addition to surgical management, adjuvant therapies, including radiation and systemic treatments, are reviewed to highlight their role in reducing recurrence and enhancing patient survival. Emerging treatments such as cryoablation, photodynamic therapy (PDT), and immunotherapy are discussed for their potential as adjuncts or alternatives to traditional surgery. Future research in the genetic and molecular profiling of MPD may provide new pathways for targeted therapies, ultimately advancing patient care and outcomes.