Hi, saw the new surgeon and had an ultrasound . He said he couldnt see cancer . He said he didnt think it was Pagets . The crusting is also on the other nipple and he suggested exfoliating under the shower with a face washer . Then apply the cream nursing mothers use for nipples . Otherwise my options were to have the nipple removed . He thinks its possibly due to my auto immune diseases both involve the skin . I think its going to take a while to get rid of . He said the surgeon who removed the milk ducts was a new surgeon .. Thanks for all your help again .