Breast Cancer

, Corinna Eleni Psomadakis2 and Bobby Buka3



(1)
Department of Family Medicine, Mount Sinai School of Medicine Attending Mount Sinai Doctors/Beth Israel Medical Group-Williamsburg, Brooklyn, NY, USA

(2)
School of Medicine Imperial College London, London, UK

(3)
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA

 



Keywords
Breast cancerBreastMalignancyPuckeringDimplingErythemaInflammationSkin changesUlcerInfiltrationDischargeDistortionPruritusCancerBreast cancerPeau d’orangeNipple inversion




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Fig. 22.1
Indurated, fixed, non-tender mamillated plaque at right outer breast


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Fig. 22.2
Rapid growth over months is a concerning feature of any lesion


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Fig. 22.3
Tissue retraction prominent at right breast


Primary Care Visit Report


A 37-year-old female with past medical history of Vitamin D deficiency presented for an annual physical exam. She was concerned about a lump in her right breast that she had first noticed about 2 months prior. She noted that the skin overlying the lump had become discolored over the past 2 months, it was sometimes tender, and the lump had been growing in size. She had no family history of breast cancer. At age 16, she had a benign breast lump in the same breast. The lump was removed at that time and an implant was placed in her right breast. The implant was then removed 2 years later, at age 18. Her last mammogram 2 years prior was normal.

Vitals were normal. On exam, around 10:00 of her lateral right breast, there was a 7 cm × 7 cm indurated area, with a central 5 cm × 3 cm area of discoloration. The lesion was purple-colored and erythematous, with central puckering .

The breast mass and associated skin changes were highly suggestive of breast cancer. The patient was referred to a breast surgeon the following day for biopsy. The mass was found to be cancerous, and the patient eventually underwent chemotherapy, a right modified radical mastectomy, and radiation therapy.


Discussion from Dermatology Clinic



Differential Dx






  • Intraductal papillary carcinoma


  • Metastatic carcinoma


  • Paget’s disease


Favored Dx


The changes in size and texture of the breast point to an internal malignancy , and the skin changes seen most likely represent local invasion of the skin by breast cancer.


Overview


Skin changes are associated with a number of internal malignancies, which can manifest in a variety of ways. These include local invasion of the skin by an adjacent cancer, metastasis to the skin from a distal cancer, and changes that are suggestive of various familial cancer syndromes. The skin changes seen in this case represent local invasion by an underlying breast cancer.

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Jun 29, 2017 | Posted by in Uncategorized | Comments Off on Breast Cancer

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