Supernumerary nipple dermoscopy

Author: Naomi Ashman, Dermoscopist, Torbay Skin, Auckland, New Zealand; DermNet New Zealand Editor in Chief, Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. April 2019.


What is a supernumerary nipple?

A supernumerary nipple is a minor malformation of mammary tissue resulting in an extra nipple and associated tissue.  It is also known as an accessory nipple or an ectopic nipple.

What are the clinical features of a supernumerary nipple?

A supernumerary nipple is present at birth. It often appears similar to a congenital organoid or melanocytic naevus. Most supernumerary nipples are much smaller than the normal areola and nipple. They may be solitary or multiple, arising on one or both sides of the nipple line. They may be pink or brown, and at least the central nipple is elevated off the skin surface. There may be a central dimple. Supernumerary nipples may develop prominent hair at puberty.

What are the dermoscopic features of a supernumerary nipple?

Accessory nipples are most commonly characterised by the occurrence of an outer network-like structure accompanied by the presence of a scar-like area [1].  Other recognised features are explained in the table below.

Dermoscopic featureDefinition
Peripheral network (network-like structures) A network of brownish, interconnected thin lines over a background of diffuse tan pigmentation, located at the periphery of the lesion
Central network-like structures A network of brownish, interconnected thin lines over a background of diffuse tan pigmentation, located centrally in the lesion
Central white scar-like area Central, sharply circumscribed, round to oval, white area within the centre of an otherwise regular, light-to-dark brown pigmented lesion
Cleft-like appearance A small rim, dividing the tip into two symmetrical parts
White cobblestone-like structures Closely aggregated, larger, angulated whitish globules resembling cobblestones
Central round dimpling with a plug Central roundish dimple filled with a darker plug
Fisheye-like structures (mimicking comedo-like openings) Small, darker (brownish or black) dots visible in the form of sharply circumscribed, usually round or oval structures, mimicking comedo-like openings
Dermoscopy images of supernumerary nipple

What is the dermoscopic differential diagnosis of a supernumerary nipple?

The differential diagnosis of a supernumerary nipple includes:

  • Dermatofibroma
  • Melanocytic naevus.

What is the histological explanation of a supernumerary nipple?

The supernumerary nipple often resembles the normal nipple.

  • Epidermal thickening
  • Mild papillomatosis and basal hyperpigmentation
  • Pilosebaceous structures
  • Smooth muscle
  • Breast ducts
  • Sometimes, underlying breast tissue

In a supernumerary nipple, the epidermis is usually papillomatous, and the normal structures seen in nipple skin are found in the dermis. These include smooth muscle, breast ductal structures and breast lobules.

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Related information

 

References

  1. Kamińska-Winciorek G, Szymszal J, Silny W. Dermoscopy of accessory nipples in authors' own study. Postepy Dermatol Alergol. 2014 31:127-33. DOI: 10.5114/pdia.2014.43189. PubMed PMID: 25097482; PubMed Central PMCID: PMC4112267.

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