<p>A 68 year-old lady was referred with a <strong>persistent non-healing patch/plaque in the right axilla</strong>. It had not responded to topical steroids and antifungal medications. There were no skin, scalp, hair or mucosal changes elsewhere. <strong>What is the most likely diagnosis?</strong></p>
<p><strong>Dermoscopy is not going to help in all lesions</strong> - as was the case here. It is very important to have a <strong>good clinical understanding of 'skin lesions'</strong> before embarking down the route of dermoscopy. Using the PCDS tables you can see there is a wide differential of skin changes that can affect the<strong> <a href="http://www.pcds.org.uk/p/general-dermatology-site#7">flexures</a>.</strong></p>
<p>The <strong>extra</strong> information required is whether there is any history of breast disease, which at the time there was not. A biopsy of the skin confirmed the suspected diagnosis of <strong>extra-mammary Paget's disease. </strong>At this site extra-mammary Paget's can be associated with breast malignancy and so the patient was referred urgently to the breast surgeons.</p>
<p>Image property of South Tees NHS Foundation Trust.<br></p>
