How to Explain a Dermal Lesion in the Breast to a Patient
When explaining a dermal lesion in the breast to a patient, clearly distinguish between skin-based lesions and breast parenchymal lesions, as this distinction is critical for proper diagnosis and treatment planning.
Understanding Dermal Lesions vs. Breast Parenchymal Lesions
- Dermal lesions are confined to the skin layers of the breast and are often benign, while lesions that appear superficial but originate from breast tissue may represent more serious conditions 1
- It's important to explain that specialized imaging techniques can determine whether a lesion is truly dermal (skin-based) or originates from breast tissue 1
- Patients should understand that dermal lesions may present as skin changes, which require proper evaluation to rule out serious conditions 2
Types of Dermal Lesions to Discuss with Patients
- Benign skin cysts are among the most common dermal lesions encountered in breast imaging 1
- Skin changes that may indicate more serious conditions include:
Diagnostic Approach to Explain to Patients
- For any unusual skin changes around the breast, evaluation typically begins with a bilateral diagnostic mammogram with or without ultrasound 2
- If imaging results are normal (BI-RADS 1-3), but skin changes are concerning, a punch biopsy of the skin or nipple biopsy may be necessary 2
- For suspicious imaging findings (BI-RADS 4-5), a tissue biopsy is recommended, with core needle biopsy being the preferred option 2
- Ultrasound is particularly helpful in determining if a lesion is truly dermal by showing if it's contained entirely within the dermis or if it extends to deeper breast tissue 1
Important Points to Address with Patients
- Reassure patients that many dermal lesions are benign, but proper evaluation is necessary to rule out serious conditions 2
- Explain that antibiotics may be given for suspected infection but should not delay diagnostic evaluation 2
- Emphasize that even with normal imaging, further workup may be needed if skin changes are clinically concerning 2
- Discuss that post-treatment skin changes (after surgery or radiation) are common and may require different management approaches 4
Follow-up Information
- If biopsy results are benign, clinical and pathologic correlation should be reassessed, and follow-up in 3-6 months may be recommended 2
- For malignant findings, explain that treatment will follow established breast cancer guidelines 2
- Patients should be advised to report any changes in the appearance of the lesion or development of new symptoms 2
Special Considerations
- For patients with a history of breast cancer, explain that certain skin changes may represent treatment effects rather than new disease 4
- Inflammatory lesions of the breast can range from acute conditions to chronic diseases and may require specialized evaluation 5
- Patients should understand that some lesions that appear to be dermal may actually be breast cancer extending into the areola 6