I have 32F patient who had a skin lesion in the right info-mammary crease excised which turned out to be Paget's disease in a supernumerary nipple. Mammograms and ultrasound scans are normal and was planning a re-excision of the ectopic nipple area.

What else would you do??

Expert Response: I recommend consideration of a preoperative breast MRI given the patient’s very young age and likelihood of heterogeneously or very dense breasts on mammogram, a preoperative genetics consultation for cancer genetic panel testing to rule out BRCA1/2, CHEK2, ATM, P53 most importantly. Then, postoperatively if there are no additional pathologic findings, a radiation oncology consultation for whole breast radiation, and adjuvant systemic therapy based on the final pathology