When eczema-like changes appear on the nipple areola, is it still in the early stage? It also depends on whether there is a breast lump, but if no lump is found, it should be in the early stage. In principle, axillary lymph node dissection may not be performed, but in practice it is difficult to do so. The rate of axillary lymph node metastasis in these patients is reported to be 0-25% in the literature, so some authors suggest that axillary lymph node dissection should be performed in all cases of paget disease. Yuan Yongxi, Department of Breast Medicine, Shanghai Longhua Hospital Does paget disease in the breast metastasize and spread? How should it be treated? Of course it will recur and spread in advanced stage. Treatment for breast cancer metastasis and spread is treated the same as chemotherapy, radiotherapy and combination therapy. What are the risks of not having surgery? Progression from nipple areola erosion to whole breast erosion. Spread from metastasis to the axillary lymph nodes to organs throughout the body, mainly the lungs, liver, brain, and bones throughout the body. Can breast paget disease be treated with breast-conserving surgery? Based on the 8 cases of breast paget disease breast-conserving surgery (both with and without lumps) that I have performed, 2 of them showed recurrence after surgery. Therefore, I believe that breast paget disease should be treated with caution with breast-conserving surgery. Do I need lymph node dissection and radiotherapy after surgery for breast paget disease? For breast paget disease with breast lumps, and the lumps are infiltrative, their recurrence and metastasis rate is high, so ipsilateral lymph node clearance should be performed; for those without lumps, axillary anterior lymph node clearance can be done; if it is negative, then a single mastectomy is performed. If breast paget disease is accompanied by breast lumps and is confirmed to be invasive intraoperatively, the principles of treatment should be similar to those for concurrent breast cancer, with appropriate radiotherapy given after surgery. Will patients who have had breast paget disease be more likely to develop it in the other breast? Bilateral paget disease in the breast is rare, but the pathology should determine whether there are multicentric lesions, and if so, the incidence of the other breast will increase. How should it be treated when combined with other breast cancers? The treatment principles should be similar to those for concurrent breast cancer, with appropriate adjuvant therapy given postoperatively.