Paget's disease of the breast presents as an eczematous lesion of the nipple. Histologically, it is characterized by malignant intraepidermal cells associated with an underlying ductal carcinoma. Paget's disease of the male breast is rare. Although melanin has been found within the malignant cells of Paget's disease, no clinically pigmented lesion has yet been reported. We present a case of pigmented Paget's disease of the male breast and review the pathogenesis of this disease.