Clinician to Clinician: A curious nipple lesion

April 1, 2005

The mother who came into my office was tense.She was worried that her 9-year-old daughter's bleeding nipple might be cancer. The lesion, the mother said, had been present for 2 months, didn't respond to cortisone cream, and, "it is getting worse."

The mother who came into my office was tense.She was worried that her 9-year-old daughter's bleeding nipple might be cancer. The lesion, the mother said, had been present for 2 months, didn't respond to cortisone cream, and, "it is getting worse."

Physical examination showed that the child did, in fact, have a nipple lesion, which bled a little on contact. There was some inflammation, evidently caused by the child's scratching. But the nipple had no lump under it nor was it ulcerated. I found no evidence of lymphadenopathy, nor of any other lesions on the girl. As I puzzled over a diagnosis, the mother told me that she had taken her child to the emergency room, to a pediatrician, and to the family physician, to no avail. Aware of the breast cancer history in her family, the mother wanted something done immediately because antibiotics and creams were not working.

I scheduled the child for a biopsy the next day, which I took under IV sedation. My only nipple biopsy, it produced excellent cosmetic results and, more importantly, a definitive diagnosis: molluscum contagiosum. No further treatment was necessary for this most unusual, solitary breast lesion.