A 50-year-old man presented with a 1-week history of a painful hard lump above his right nipple. He attended the Accident and Emergency Department when the lump suddenly grew bigger and more painful. He had been unwell for 4 weeks, with a productive cough, loss of appetite, and weight loss. He was normally well, and there was no relevant medical history. He smoked 50 cigarettes a day and drank excessive quantities of alcohol each week. He worked in a warehouse and had not traveled outside the United Kingdom. On examination, he was comfortable at rest and did not look unwell. He was apyrexial, and oxygen saturations were 98% on room air. His BP was 110/70 mm Hg, and pulse rate was 90 beats/min. There was a large, hard, tender mass above his right nipple associated with some bruising of the skin. On auscultation of his chest, a few crackles were audible. His dentition was poor. The remainder of his physical examination was normal.