Accessory nipple over the right scapula of a 14-year-old boy: An extremely rare and unreported location, case report

Highlights • The nipples or breasts can occur along the so called milk line, between the armpit and anterior thigh.• Breast neoplasm may develop in ectopically located glandular tissue.• Accessory breast cancer is usually diagnosed by clinical examination and ultrasonography.

This term can be applied when more than 2 breasts present in human beings [5].
The frequency has been estimated to be around 1/500 and usually seen in the anterior aspect of the trunk, in the embryonic milk line. Most lesions are smaller than the normal nipple appearing as small spots of 2-3 mm in diameter [6,7]. Cases has been reported in rare locations like the face [1].
This the work has been reported in line with the SCARE criteria [8].

Patient information
A 14-year-old boy presented to the surgical consultation room because his mother was worried about a round brown skin lesion over the right scapula which enlarged in size and became deeper in color over the last year, there were no symptoms associated with this lesion but the family was worried about it. There were no relevant past medical, past surgical, or family histories for the chronic illnesses or skin diseases. E-mail address: ayad.mohammed@uod.ac

Clinical findings
During examination the lesion was a round, brown, and slightly elevated from the skin surface. The size was about 1 cm in diameter with central projection. The location of the mass was in the region of the right shoulder, Fig. 1.

Diagnostic assessment
On the basis of this clinical appearance the condition diagnosed as a supernumerary nipple located in this site. This is an extremely rare location, and no case has been reported before.

Therapeutic intervention
No specific therapeutic work up done.

Follow-up and outcomes
The family was reassured about the diagnosis and the patient sent home to be followed if any symptom developed in the future.

Discussion
The supernumerary nipples are more common in males and most of them occur in the left side [9].  It may be familial and reported in many generations of some families [10,11].
If associated with excessive breast tissue it may become noticeable at puberty due to hormonal effect, or enlarge during pregnancy and lactation [4].
The diagnosis needs high index of suspicion, and sometimes in unclear situations may need histological confirmation which shows all the histological structures seen in the normal nipple like mammary glands and smooth muscles [2,6].
It may present as cosmetic concern and usually they are not associated with other congenital anomalies [2,12].
Accessory breasts may have the potential to develop the same benign and malignant disorder as normal breast tissue [5,13].
In most cases it may not need any intervention, however it may be removed surgically if there is cosmetic concern, uncertainty of the diagnosis, or the development of any kind of symptoms [4].

Conflicts of interest
The author has no conflicts of interest to declare.

Sources of funding
None.

Ethical approval
This case reports not needed ethical approval.

Consent
The father of the patient has provided me with a written informed consent to publish this finding of his son, and the identity of the patient has been protected.

Author's contribution
The concept of reporting the case, drafting, and revision of the case done by Dr Ayad Ahmad Mohammed.

Registration of research studies
This work is case report and there is no need of registration.

Guarantor
Dr Ayad Ahmad Mohammed is guarantor for the work.

Provenance and peer review
Not commissioned, externally peer-reviewed.