Hyperkeratosis of the Nipple and Areola Workup

Updated: Mar 17, 2022
  • Author: Rabindranath Nambi, MD; Chief Editor: Dirk M Elston, MD  more...
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The acquisition of a skin biopsy sample for histopathologic examination aids in differentiating nevoid hyperkeratosis of the nipple and/or areola from other conditions. The preferred method involves a 3- or 4-mm punch biopsy followed by closure with 6-0 Prolene sutures. An alternative suture material (eg, 5-0 or 6-0 plain gut [absorbable] suture) may be used if desired. This method provides the best cosmetic results, with minimal scarring and maintenance of the normal architecture of the nipple and/or areola.


Histologic Findings

Primary hyperkeratosis of the nipple and/or areola is characterized by variable orthokeratotic hyperkeratosis, slight acanthosis, and marked papillomatosis changes on routine hematoxylin and eosin–stained specimens. Additional findings reported include mild dermal lymphocytic perivascular inflammation [36, 38, 39] and epidermal spongiosis with microabscesses with normal lymphocytes. [40, 41] Histopathological features and an immunophenotype that paralleled those of mycosis fungoides have been reported. [41, 42] Immunostaining demonstrated epidermal infiltrate with CD3, a predominance of CD4 compared with CD8, and absence of CD7 expression. However, in both cases, no clonal T-cell population was identified.

In secondary hyperkeratosis of the nipple and/or areola, biopsy samples may reveal histologic findings related to the associated skin disease. An example includes cutaneous T-cell lymphoma–associated hyperkeratosis of the nipple and/or areola histology, which reveals epidermotropism with atypical lymphocytes. [17]