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A 47-year-old woman presented with a single itchy, hyperpigmented plaque over her right nipple, which had been present for 2 weeks (Fig. 1A). The lesion was approximately 3.2 × 2.5 cm in size. Nipple retraction and ulceration were absent. Physical examination revealed no palpable mass within the breasts or regional lymphadenopathy. She reported no prior systemic disease, had no family history of breast cancer, and denied taking any drugs, including contraceptives. An incisional biopsy of the plaque revealed epidermal pagetoid spreading of tumour cells, which had hyperchromatism, nuclear pleomorphism and atypical mitosis, in addition to upper dermal lymphocytic inflammation. The presence of melanin pigmentation around the tumour cells within the epidermis and marked occurrence of melanophages in the upper dermis were noted (Fig. 1B). Immunohistochemical staining results showed that the tumour cells were positive for cytokeratin 7 (CK7) but negative for S-100 and MiTF. What is your diagnosis? See next page for answer. A Hyperpigmented Plaque on the Right Nipple: A Quiz