Typical signs of Paget disease are erythema, eczema, scaling, erosion, ulceration and retraction of the nipple-areolar complex that may mislead to a diagnosis of a benign dermatological lesion.
In this case, there was a high index of suspicion toward underlying breast malignancy as patient also had a bloody nipple discharge.
The common histological type of breast carcinoma in Paget disease is DCIS which is a centrally-located tumor. However a peripherally-located tumor (as in this case), commonly have multifocal multicentric lesions because tumors spread along the ducts and show invasive carcinoma. The other histological type is microinvasive carcinoma.