Paget Breast disease i a kind of intraductal carcinoma that through an intracanalicular diffusion invades the basal epidermical layer, reaching the areola and nipple, producing a typical erythematous desquamative eczematous-like lesion this neoplasia can remain undetected for a long time and inadeguately trated as a dermatological affection. Synchronous or metachronous lesions are very uncommon. From our experience we think that lesion biopsy is always necessary to formulate a correct diagnosis and to schedule an appropriate therapeutic approach. In our case a biopsy was performed first, than on the basis of the frozen sction analysis a radical mastectomy with axillary third level lynphonodes dissection, because of the large dimension of the lesion and the previous history of metachronous lesion
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