From the Guidelines
Skin changes associated with breast cancer can be important warning signs that require immediate medical attention, and the most concerning skin changes include dimpling or puckering of the breast skin, redness or darkening of the breast skin, thickening of skin, visible swelling, and nipple changes such as inversion, discharge, or crusting, as noted in the NCCN guidelines 1.
Key Skin Changes to Monitor
- Dimpling or puckering of the breast skin (resembling an orange peel texture, called peau d'orange)
- Redness or darkening of the breast skin
- Thickening of skin
- Visible swelling
- Nipple changes such as inversion, discharge, or crusting These changes can occur due to cancer cells blocking lymphatic vessels in the skin, causing fluid buildup and inflammation, or directly invading the skin tissue, as described in the guidelines for breast cancer diagnosis and treatment 1.
Importance of Early Detection
Early detection through awareness of these skin changes can lead to earlier diagnosis and treatment, potentially improving outcomes, as emphasized in the guidelines for breast cancer screening and diagnosis 1.
Recommendations for Evaluation and Diagnosis
Any persistent skin change on the breast that lasts more than two weeks should be evaluated by a healthcare provider, even if there is no detectable lump, and a bilateral diagnostic mammogram with or without ultrasound imaging should be performed as the initial evaluation, followed by further workup based on imaging findings, as recommended in the NCCN guidelines 1.
From the Research
Cutaneous Manifestations of Breast Cancer
The cutaneous manifestations associated with breast cancer can be diverse and varied. Some of the common presentations include:
- Metastatic cutaneous lesions, which can appear as nodules, plaques, or diffuse skin thickening 2
- Paraneoplastic cutaneous dermatoses, such as erythema gyratum repens, acquired ichthyosis, dermatomyositis, multicentric reticulohistiocytosis, and hypertrichosis lanuginosa acquisita 3
- Mammary Paget's disease, often associated with an underlying breast cancer 3
- Cowden syndrome, which has an increased risk of breast malignancy and specific dermatologic findings 3
- Inflammatory, nodular, telangiectatic, and scirrhous variants of local metastatic or recurrent disease 4
- Radiation changes, including skin ulceration, fibrosis, and necrosis, as well as the development of secondary malignancies such as angiosarcoma 5
Skin Metastasis in Breast Cancer
Skin metastasis is a rare but possible presentation of breast cancer. It can occur as a initial presentation or as a recurrence after treatment 6, 2. The assessment of skin metastasis can be challenging due to its benign-appearing clinical presentation 2. Awareness of the diverse manifestations of skin metastasis is crucial for early diagnosis and management.
Treatment-Related Cutaneous Manifestations
Treatment of breast cancer, including surgery and radiation, can result in various cutaneous complications. These include:
- Postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders 5
- Radiation-induced skin changes, such as dermatoses, skin ulceration, fibrosis, and necrosis 5
- Secondary malignancies, such as angiosarcoma, and rarer dermatologic diseases, such as radiation-induced morphea and lichen planus 5