AANP Lightning Round Practice Test

Persistent unilateral changes of the nipple-areola in an older woman are concerning for an underlying breast malignancy, such as Paget disease of the breast. When a lesion on the nipple does not respond to potent topical steroids after several months, it’s essential to move beyond symptomatic treatment and evaluate for cancer. The best next step is to obtain imaging with a mammogram to assess for underlying ductal carcinoma in situ or invasive cancer and to refer to a breast surgeon for further diagnostic workup and management. Mammography is the appropriate first-line imaging in this setting; MRI can be considered later if mammography is inconclusive or if high-risk features exist, but it is not the initial test. Reassurance or merely increasing topical therapy would miss a potential malignancy, and delaying imaging could allow cancer to progress.