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
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