Cutaneous breast cancer
Cutaneous breast cancer refers to the metastatic spread of primary breast cancer to the skin, primarily manifesting as skin lesions on or near the affected breast, but can also appear on other body areas such as the axilla, back, and face. This condition is relatively rare, occurring in 1 to 10 percent of metastatic cancers, with breast cancer responsible for approximately 30 percent of cutaneous metastases. It is notably associated with individuals who have a history of breast cancer, though the reasons for why some breast cancers metastasize to the skin remain unclear. Symptoms typically include various skin changes, most commonly reddened nodules or papules, and can also present as inflamed patches or larger plaques. Diagnosis is confirmed through skin biopsy, and cutaneous breast cancer is considered a sign of advanced disease, indicating Stage III or IV breast cancer. Treatment options aim to improve the patient's quality of life and may involve surgical excision, photodynamic therapy, or systemic chemotherapy, among others. Unfortunately, the prognosis for patients with cutaneous breast cancer is generally poor, with many individuals facing limited survival time after diagnosis. Understanding this condition is crucial for those affected and for fostering compassion in treatment and support efforts.
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Cutaneous breast cancer
RELATED CONDITIONS: Inflammatory breast cancer (IBC), melanoma of the breast, Paget disease of the breast
DEFINITION: Cutaneous breast cancer is the metastatic spread of primary breast cancer to the skin. The most common site of skin metastases is to the affected breast, but it may also to the axilla, back, scalp, face, neck, extremities, around the ear, and above the clavicle.
Risk factors: Although cutaneous cancer can occur with many types of cancer, it is most common with breast cancer and is associated with a history of breast cancer. It is not known why some breast cancers metastasize to the skin.
Etiology and the disease process: Cutaneous breast cancer develops when cancer cells invade the bloodstream or lymphatic system. For cutaneous cancer to develop, the cancer cells must evade the body’s immune defenses and then settle on the skin, where they invade the tissue.
Incidence: Cutaneous breast cancer is relatively rare. Cutaneous metastasis occurs in 1 to 10 percent of metastatic cancers, and of all occurrences of cutaneous metastasis, breast cancer accounts for 30 percent of cases. Some experts estimate that 0.7 to 10.4 percent of breast cancer patients will develop skin metastases.
Symptoms: The symptoms of cutaneous breast cancer are changes in the skin, most commonly over the site of the primary breast cancer or on the mastectomy incision. Several types of cutaneous lesions can develop. The most common are reddened nodules (lumps) and papules (pimple-like lesions). There may also be purple papules, nodules, and plaques (flat, raised patches). Sometimes, only a reddened, raised patch develops. The patch appears inflamed and has a defined margin. The last type is a large, purple plaque infiltrating the tissue.
Screening and diagnosis: There is no screening in particular for cutaneous breast cancer. A diagnosis of cutaneous breast cancer is verified by skin biopsy. Cutaneous breast cancer is not staged as a separate entity because it is a sign of metastases of breast cancer and indicates Stage III or IV breast cancer.
Treatment and therapy: Cutaneous breast cancer may be surgically excised, treated with photodynamic therapy, or cryotherapy (freezing). Systemic chemotherapy may be administered, or a topical cream called imiquimod 5 percent (Aldara) may be applied. The use of intensity-modulated radiation therapy (IMRT) avoids normal, healthy tissues and targets affected areas with high doses of radiation. IMRT is also effective in reirradiation. Electrochemotherapy (ECT) treats pain and bleeding by delivering low-dose chemotherapy through electrical impulses. Treatment is performed to improve the patient’s quality of life.
Prognosis, prevention, and outcomes: Because it is a sign of advanced breast cancer, the presence of cutaneous breast cancer is indicative of a poor prognosis. The determination of a patient's outlook depends on the details of the primary tumor. Most individuals with advanced-stage breast cancer live less than one year after diagnosis. There is no way to prevent it.
Bibliography
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