Paget disease of the nipple: lines of therapy

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4 standard-of-care settings across 3 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	HER2
Screening, prevention and diagnosis	1	·
Early / localised	1	·
Other settings	1	1

Screening, prevention and diagnosis

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Diagnosis	Punch or wedge biopsy of the nipple for any eczema-like change not settling within a few weeks, with bilateral mammography and breast MRI to map the disease behind it.	Core needle biopsy and fine-needle aspiration (FNA)Histopathology & immunohistochemistryMammography & tomosynthesisMRI		95

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Localised disease	Central breast-conserving surgery removing the nipple-areola complex and underlying tumour with clear margins followed by whole-breast radiotherapy, or mastectomy for extensive or multicentric disease.	Lumpectomy (breast-conserving surgery)MastectomyHypofractionated radiotherapy		32

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Axilla	Sentinel node biopsy when invasive carcinoma is present or when mastectomy is planned; not needed for Paget disease with in situ disease treated by breast conservation.	Sentinel lymph node biopsy		68
HER2	Systemic therapy	Determined by the underlying carcinoma: endocrine therapy, chemotherapy and HER2-directed treatment on the same criteria as other breast cancers.	TamoxifenTrastuzumabHER2-positive breast cancerHR-positive / HER2-negative breast cancerDuctal carcinoma in situ (DCIS)		89

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.