Video Topics

Skin Metastasis Breast

About 70% of all cutaneous metastases in women are related to breast cancer. Skin involvement occurs in 24% of breast cancer cases. It is the presenting sign 3.5% of the time. Several distinct clinical patterns of metastatic breast cancer are recognized: 1. Inflammatory metastatic breast carcinoma resembles erysipelas in the anterior chest but without fever or tenderness. It is caused by capillary congestion.

2. En cuirasse metastatic breast carcinoma is a diffuse morphea-like induration of skin that begins as scattered, firm, lenticular papulonodules that coalesce. Local lymphatic spread is possible.

3. Telangiectatic metastatic carcinoma, the violaceous papulovesicles resemble lymphangioma circumscriptum. There is local lymphatic spread. It may be pruritic and may resemble vasculitis.

4. Nodular metastatic carcinoma, multiple firm papules or nodules appear on the anterior chest. They may be ulcerated and may suggest melanoma or pigmented basal cell carcinoma.

5. Alopecia neoplastica has asymptomatic, non-inflammatory, circular areas of alopecia. There is distant hematogenous spread. 6. Paget’s disease of the breast, there is a sharply defined plaque of erythema and scaling on the breast, suggestive of eczema, but the eruption is persistent. It is usually unilateral but may be bilateral. This represents a direct spread from underlying breast cancer. The most common representation of cutaneous breast metastasis is an aggregate of discrete, firm, nontender, skin-colored nodules that appear suddenly, grow rapidly, attain a certain size (often 2 cm), and remain stationary.