Pagetoid squamous cell carcinoma in situ (Pagetoid bowen's disease) of the nipple in an older male patient: a case report and literature review.

Background: Pagetoid Bowen's disease (PBD) is a rare histological type of skin squamous cell carcinoma in situ. Due to its atypical pathological changes, it is often misdiagnosed and missed in clinical practice, making it difficult to diagnose. This is a rare report of unilateral nipple area PBD in an older male patient, providing insights into the diagnosis and treatment planning of PBD.

Case presentation: Here, we report the case of a 65-year-old Asian man with skin manifestations, such as erythema, scaling, erosion, and exudation of the left nipple. He had been treated for eczema for a long time without improvement, and his condition had recurred and worsened. Histopathological examination revealed scattered Pagetoid cell nests in the epidermis, an atypical manifestation of PBD. Sex and the specific site of the patient are rare in all PBD case reports. We made an accurate diagnosis by combining skin histopathology, immunohistochemistry, and other clinical examinations. Radical surgery was performed on a skin tumor located on the patient's left nipple.

Conclusions: This case suggests that when clinicians encounter situations in which clinical morphology and histopathology cannot provide a panorama of the disease, immunohistochemical examination becomes crucial for confirming the diagnosis. An accurate understanding of PBD can reduce the misdiagnosis rates of mammary Paget's disease (MPD) and superficial disseminated melanoma.