II. History

  1. Nipple Scaling
  2. Nipple Retraction
  3. Redness or Warmth
  4. Skin thickening
  5. Dimpling
  6. Duration
  7. Location
  8. Changes

III. Normal Variation

  1. Montgomery glands
    1. Prominent and visible as bumps around areola
  2. Nipple Inversion
    1. Congenitally present
    2. Differentiate from Nipple retraction

IV. Infections

  1. Intertrigo
    1. Commonly occurs in folds of pendulous Breasts

V. Abnormal Findings (Red Flags)

  1. Nipple retraction
    1. Cancer until proven otherwise!
    2. Suggests retroareolar mass
  2. Paget's Disease of the Nipple
  3. Skin Retraction
  4. Skin Dimpling
  5. Peau d'orange
    1. Breast skin dotted like skin of an orange
      1. Not orange color
    2. Very ominous sign
      1. Suggests lymph node involvement
  6. Breast Erythema in non-lactating women
    1. Ominous if persistent Mastitis greater than 2 weeks
    2. Suggests inflammatory carcinoma

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