The use of touch/scrape smears for cytological diagnosis is recommended to prevent delay in diagnosis. Mainly in patients who are reluctant to undergo other diagnostic procedures such as wedge biopsy, shave biopsy, surgical excision. A negative result does not exclude the diagnosis of Paget’s disease of the breast. In vivo reflectance confocal microscopy allows visualization of the upper layers of the skin at a cellular resolution, may also assist in the early diagnosis of Paget’s disease in reluctant patients.

• The use of touch/scrape smears for cytological diagnosis is recommended to prevent delay in diagnosis.
• Mainly in patients who are reluctant to undergo other diagnostic procedures such as wedge biopsy, shave biopsy, surgical excision.
• Due to the difficulty in differentiating Paget’s disease from inflammatory skin conditions or squamous neoplasia on cytology, a biopsy of the nipple and areola is generally preferred for definitive diagnosis.
• Cytology of skin scrapings many time display the presence of:

• Single malignant cells with vacuolated cytoplasm and eccentric nuclei
• Three dimensional cell aggregates
• Acinar groups consistent with glandular differentiation

• A negative result does not exclude the diagnosis of Paget’s disease of the breast.^[1][2]

In vivo reflectance confocal microscopy allows visualization of the upper layers of the skin at a cellular resolution, may also assist in the early diagnosis of Paget’s disease in reluctant patients.