Rewriting the history of Paget's disease: From Arderne's medieval case to Crocker's first extramammary description...

The conventional history of Paget's disease begins with Sir James Paget's 1874 description of chronic nipple-areolar change preceding breast carcinoma. Re-examination of earlier primary sources, however, reveals a far longer and more complex history. This article reconstructs the evolution of Paget's disease from the late medieval period to the end of the nineteenth century. A Middle English manuscript by John of Arderne (ca. 1370) contains what may represent the earliest identifiable clinical description of a Paget-like nipple lesion, notably in a male patient. In the nineteenth century, Alfred Velpeau (1841) provided the first modern and detailed clinical account, but his observations remained overlooked because he did not define a distinct clinicopathological entity. Paget's 1874 paper transformed earlier, scattered observations into a coherent syndrome with prognostic significance. Subsequent authors further expanded the clinical spectrum: Forrest (1880) reported the first modern male case, and Crocker (1889) established extramammary Paget's disease as a parallel entity. By critically reassessing medieval manuscripts, nineteenth-century surgical texts, and early dermatological reports, this study reconstructs the historical trajectory of Paget's disease and corrects persistent misinterpretations in the literature. It demonstrates that the conceptual foundations of Paget's disease extend more than five centuries before its formal naming, offering a revised and resource-based historical framework.