A woman aged 40 years presented to her general practitioner (GP) with a changing plaque on her left breast. She stated that it had appeared over the prior year and was mildly itchy, and she thought it had been triggered by her toddler scratching the location during breastfeeding. Three months ago she initiated a course of clotrimazole 1% cream with no effect. Her background included Hashimoto’s thyroiditis and vulval lichen sclerosus, for which she received annual vulvoscopy by a gynaecologist. On examination, there was a circumscribed 3 × 3 cm indurated, hypopigmented plaque on her left lateral breast (Figure 1). There was lack of hair, and it had a wrinkled appearance. Examination of her breasts, skin, hair and nails was otherwise unremarkable.