Massive cutaneous metastases as a first symptom of breast cancer — a case study
Abstract
Introduction: Metastases to the skin are relatively rare, but they are an important diagnostic and therapeutic challenge. In women skin metastases are the most commonly associated with breast cancer. In the men they are often associated with lung cancer. Skin metastasis most often are in form of blue-purple nodules and tumours with tendency of necrosis.
Aim: The aim of this paper is to present the case of a patient with diagnosed breast cancer with skin involvement.
Case report: The 48-years old female patient was admitted to The Department of Dermatology for diagnosis and treatment of dermal lesions in form of numerous blue-purple nodules and ulcerations localised on the skin of the chest. The ultrasound examination suggested a primary malignant lesion in the left breast spreading to the right side and numerous satellite nodules. A whole nodule was collected for histopathological and immunohistochemical examinations in order to make the final diagnosis. Histopathology tests confirmed the diagnosis of tumour metastases of the skin and positive immunohistochemical reactions for cytokeratin 7 (CK7) and for oestrogen receptors (ER) pointed mammary glands as the primary site. The patient was urgently referred to the Oncology Centre.
Conclusions: The occurrence of skin metastasis in all tumour processes significantly worsens the prognosis of the patient. These changes should be quickly recognized by the oncologist or dermatologist. Sometimes the localization of primary tumour is not possible to determine without taking the biopsy for histopathological and immunohistochemistry assays. Rapid treatment of appropriate chemotherapy or radiotherapy can prolong life and reduce pain.
Keywords: skin metastasesbreast cancersatellite nodules
References
- Alcaraz I, Cerroni L, Rütten A, et al. Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol. 2012; 34(4): 347–393.
- Brownstein MH, Helwig EB. Metastatic tumors of the skin. Cancer. 1972; 29(5): 1298–1307, doi: 10.1002/1097-0142(197205)29:5<1298::aid-cncr2820290526>3.0.co;2-6.
- Schwartz RA, Schwartz RA. Cutaneous metastatic disease. J Am Acad Dermatol. 1995; 33(2): 161–185.
- Lookingbill DP, Spangler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients. J Am Acad Dermatol. 1993; 29(2 Pt 1): 228–236.
- Strohl RA. Cutaneous manifestations of malignant disease. Dermatol Nurs. 1998; 10(1): 23–25.
- Kamińska-Winciorek G, Wydmański J, Januszewski K, et al. Dermoscopy of nodular skin metastases from the gastrointestinal primary cancer. Postepy Dermatol Alergol. 2015; 32(4): 312–316.
- Kamińska-Winciorek G, Wydmański J. Dermoscopy of skin metastases from breast cancer and of the orange peel type ("peau d'orange"): a report of two cases. Int J Dermatol. 2015; 54(3): 343–346.
- Weimann ET, Botero EB, Mendes C, et al. Cutaneous metastasis as the first manifestation of occult malignant breast neoplasia. An Bras Dermatol. 2016; 91(5 suppl 1): 105–107.
- Tazbir M, Broniarczyk-Dyła G, Pluta P. Massive isolated breast carcinoma metastases to the skin. A case report. Post Dermatol Alergol. 2009; XXVI. ; 6: 547–549.
- Zygulska AL, Krzemieniecki K. Długoletnie leczenie trastuzumabem chorej na raka piersi z przerzutami do skóry – opis przypadku. Onkol Prak Klin. 2010; 6. ; 3: 113–115.
- Fidler S, Kaj J, Płochocki M, et al. Upper limb amputation in the course of skin metastases of rectal cancer. Onkol Prak Klin. 2007; 3(5): 259–262.
- Wichtowski M, Potocki P, Kufel-Grabowska J, et al. Electrochemotherapy in the Treatment of Massive, Multisite Breast Cancer Metastasis to the Skin and Subcutaneous Tissue: A Case Report. Breast Care (Basel). 2016; 11(5): 353–355.
