February 2004





History: 54-year-old woman complained of a painless, nonpruitic, nonhealing ulcer on her left nipple for 6 months. The patient denied any discharge. The past medical history includes hypertension and the family history was positive for breast cancer of unknown type in her sister and aunt. Mammogram and ultrasound showed a hypervascular nipple mass.

Physical exam: On physical exam she had a 1.3 by 1.5 cm palpable mass covering 90% of her nipple. (Figure 1) There was no peripheral infiltration, no discharge, and no axillary lymphadenopathy. The left nipple was 2 cm higher than the right nipple. Nipple to midline distance was 12 cm on the left and 11 cm on the right. She had moderate fibrocystic changes throughout both breasts.



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