Cutaneous Manifestation of Breast Cancer: Case Report

Abstract

Breast cancer is the most common tumour to metastasize to the skin in women. The incidence of cutaneous metastases from breast carcinoma ranges from 23.9 – 26.5%. Cutaneous manifestations can present in various morphological and histological forms and may herald the diagnosis or recurrence of breast cancer itself.  This paper is presenting two case reports for rare metastatic presentation of breast cancer. A 70-year-old Indian lady was diagnosed with Stage IIb left breast cancer in 2004. She underwent left mastectomy and axillary clearance, adjuvant chemotherapy with 6 cycles of FAC regime and completed hormonal treatment with Tamoxifen for five years. Unfortunately, she had disease progression in 2011 as she developed distant metastases to the bronchus and mediastinum. She was given targeted radiotherapy and palliative chemotherapy along with a second line hormonal therapy with Letrazole. In April 2017, she developed multiple non-healing cutaneous ulcers over the right deltoid and left infra-scapular region for two months. A CT Scan revealed no involvement of the underlying muscle while the histopathological examination revealed it being a metastatic lesion.  She then underwent palliative radiotherapy to the right deltoid and AI was changed to Exemestane. Another 54-year-old Malay lady, who previously defaulted follow-ups, was diagnosed with bilateral advanced invasive lobular breast cancer in December 2015 when she presented with pathological fractures from C6-L5. The Spine Team adopted a conservative approach with a Jewett’s Brace and palliative chemotherapy was commenced for her with 6 cycles of Paclitaxel. She was also noted to have multiple skin lesions since April 2016 of which a biopsy revealed metastatic carcinoma to the skin. Conclusion: Albeit rare, any new and persistent dermatological presentation in patients with breast cancer should be promptly acknowledged and investigated to allow earlier intervention in treating the systemic spread of the disease.