From the Guidelines
Peau d'orange is a clinical sign that requires immediate medical evaluation, especially when accompanied by other symptoms such as redness, warmth, swelling, or a breast mass, as it can be indicative of inflammatory breast cancer, an aggressive form of cancer that necessitates prompt treatment. This condition is characterized by skin that resembles the dimpled surface of an orange peel, resulting from the blockage of lymphatic vessels in the skin by cancer cells, leading to lymphatic fluid buildup, edema, and skin thickening with prominent hair follicles. While peau d'orange is most commonly associated with inflammatory breast cancer, it can also appear in other conditions, including severe breast infections (mastitis), advanced lymphedema, or certain skin diseases. According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline [ 1 ], it is essential to counsel survivors on how to prevent or reduce the risk of lymphedema, which can be a precursor to or associated condition with peau d'orange. Key points to consider in the management of peau d'orange include:
- Immediate medical evaluation for any new onset of peau d'orange, especially if accompanied by other concerning symptoms
- Diagnosis typically involves clinical examination, imaging (mammogram, ultrasound, MRI), and tissue biopsy
- Treatment depends on the underlying cause, with cancer treatment usually involving a multimodal approach including chemotherapy, surgery, and radiation, and infectious causes requiring appropriate antibiotics
- Referral to a therapist knowledgeable about the diagnosis and treatment of lymphedema, such as a physical therapist, occupational therapist, or lymphedema specialist, for patients with clinical symptoms or swelling suggestive of lymphedema [ 1 ].
From the Research
Definition and Characteristics of Peau d'Orange
- Peau d'orange, which translates to "orange peel" in French, is a condition characterized by a dimpled appearance of the skin, often associated with breast cancer 2, 3, 4.
- It is often seen in inflammatory breast carcinoma, a rare and aggressive form of invasive breast cancer 3, 4.
- The condition is caused by the blockage of lymphatic vessels in the skin, resulting in edema and the characteristic dimpled appearance 2.
Diagnosis and Treatment of Peau d'Orange
- Peau d'orange is often diagnosed through a combination of physical examination, mammography, sonography, and breast magnetic resonance imaging 3, 4.
- The treatment of peau d'orange typically involves a multimodal approach, including chemotherapy, surgery, and radiation therapy 4.
- In some cases, surgery may be performed to achieve local control of cancer, but the placement of excision lines through areas of peau d'orange is often avoided due to the risk of recurrence 2.
Histopathological Features of Peau d'Orange
- Studies have shown that tumor cells can be present in the lymphatic vessels in areas of peau d'orange, which can lead to an incomplete cancer operation if excision lines are placed in these areas 2.
- The presence of malignant cells in lymphatic vessels can be correlated with lymph node pathology, and the administration of neo-adjuvant chemotherapy may affect the presence of tumor cells in these areas 2.