Differential Diagnosis for Dark Brown/Black Raised Patch on Nipples in a 60-Year-Old Woman
Single Most Likely Diagnosis
- Nipple-areolar melanosis: A benign condition characterized by hyperpigmentation of the nipple and areola, which can present as dark brown or black patches. It's more common in women and can be influenced by hormonal changes.
Other Likely Diagnoses
- Seborrheic keratosis: A common benign skin growth that can appear as a dark, raised patch, often in older adults. While not exclusive to the nipple area, it can occur there.
- Dermatosis papulosa nigra: A condition that causes small, dark, raised spots, typically on the face, but can also appear on the nipple-areolar complex.
- Nipple adenoma (florid papillomatosis): A benign tumor of the breast that can cause a raised, pigmented lesion on the nipple.
Do Not Miss Diagnoses
- Melanoma: Although less likely, melanoma can present as a new or changing pigmented lesion on the nipple. Given its potential for malignancy and the importance of early detection, it must be considered in the differential diagnosis.
- Paget's disease of the breast: A rare form of breast cancer that can present with eczematous changes or a pigmented patch on the nipple, making it crucial not to miss.
Rare Diagnoses
- Nevus of the nipple: A benign melanocytic nevus that can occur on the nipple, presenting as a pigmented lesion.
- Accessory nipple (polythelia): A rare congenital condition where extra nipples are present, which can sometimes be mistaken for a pigmented lesion if not fully formed.
- Malignant melanotic macule of the nipple: An extremely rare condition that presents as a pigmented macule on the nipple with malignant potential.