Patient presents with nipple symptoms and potential malignancy

A 55-year-old woman with a history of ductal carcinoma in situ presents with back pain and persistent redness, soreness, and bloody discharge from her left nipple. She has not responded to topical treatments for her symptoms. Examination shows the left nipple is erythematous with scaling, crusting, and ulceration. Diagnostic imaging reveals no new masses, but ultrasound indicates thickening of the nipple-areolar complex. A punch biopsy of the nipple shows large, pale-staining cells with hyperchromatic nuclei in the epidermis, raising concerns about potential malignancy. Further management will depend on the biopsy results and clinical findings.