NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Paget’s Disease

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

WORKUP

TREATMENT

Breast and NAC biopsy negative

Clinical follow-up Re-biopsy if not healing

Breast DCIS b and NAC Paget’s

See NCCN Guidelines for Noninvasive Breast Cancer for DCIS (DCIS-1)

Core biopsy of breast lesion and full-thickness skin biopsy of involved NAC

Examination or imaging positive for breast lesion

Appropriate systemic adjuvant therapy as clinically indicated See NCCN Guidelines for DCIS or Invasive Breast Cancer

Breast invasive cancer and NAC Paget’s b

See NCCN Guidelines for Invasive Breast Cancer (BINV-1)

Central lumpectomy including NAC with whole breast radiation therapy or Total mastectomy c ± sentinel node biopsy with or without breast reconstruction or Central lumpectomy including NAC ± sentinel node biopsy without radiation therapy (category 2B)

Breast negative for cancer and positive NAC Paget’s b

Consider MRI and tissue sampling

NAC biopsy positive for Paget’s b

Examination and imaging negative for breast lesion

Full-thickness skin biopsy of involved NAC

Clinical follow-up Re-biopsy if not healing

NAC biopsy negative for Paget’s

Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. b To assess the extent of disease or to confirm additional disease, consider MRI. See Principles of Dedicated Breast MRI Testing (BINV-B) . c Mastectomy is always an option with any manifestation of Paget’s disease ( See Discussion section ).

PAGET-2

Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines ® and this illustration may not be reproduced in any form without the express written permission of NCCN ® .