Breast Cancer and Dermatomyositis: A Case Study and Literature Review

Abstract

A 49-year-old woman presents with an extensive violaceous rash, rapidly progressive proximal muscle weakness, and dysphagia to solids, consistent with a diagnosis of dermatomyositis. Two weeks later, she palpates a mass in her left breast and is diagnosed with her2-positive metastatic invasive ductal carcinoma of the breast.There is a well-established association between dermatomyositis and malignancy. However, the specific association between breast cancer and dermatomyositis has not been well characterized. No guideline for oncologists managing these patients has been established. Recently, 3 cases of breast cancer and dermatomyositis were diagnosed at our institution. A review of the literature was pursued to characterize the association between breast cancer and dermatomyositis.A review of 178 papers identified 22 cases of breast cancer with dermatomyositis. Most patients (71%) presented with stage iii or iv breast cancer. The median time between the diagnosis of breast cancer and the onset of dermatomyositis symptoms was 1 month. Three quarters of the patients were steroid-responsive and able to taper. Half the women with follow-up data experienced a documented cancer relapse associated with a new flare of cutaneous symptoms.The presence of dermatomyositis appears to be associated with more-advanced breast cancer stage and is most commonly associated with invasive ductal carcinoma. In our review, treatment of cancer alone is insufficient to adequately control the cutaneous and myopathic manifestations of dermatomyositis, which can significantly affect quality of life. A multidisciplinary approach, including close collaboration with rheumatologists and dermatologists, is therefore important in the diagnosis and management of oncology patients with dermatomyositis.

Malignancy in a retrospective cohort of 17 patients with Dermatomyositis or Polymyositis in southern Tunisia

“…These cancers are dominated by breast cancer in women (41% in our series) [7,9,25] and lung cancers in men [7,9]. According to Hendren et al, the presence of DM is associated with moreadvanced breast cancer stage and is most commonly associated with invasive ductal carcinoma [26]. Other cancers were reported especially colorectal cancers, cancers of the ovary [3], the nasophagynx, the prostate [27,28].…”

Clinico-Immunological Profile of a 67-Year-Old Woman Affected by HER2-Positive Breast Cancer and Autoimmune Dermatomyositis

“…Approximately 15-30% of DMs are associated with underlying malignancies (4). Although DM may be a systemic manifestation of cancer, is not the consequence of a skin tumor invasion (12).…”

Dermatomyositis: A Presenting Clinical Vignette in a Patient With Breast Cancer

“…Breast cancer usually presents with a palpable mass, abnormal mammogram during screening time, or symptoms related to metastases. It rarely manifests as a paraneoplastic syndrome, like DM [ 9 ].…”

“…It is a rare diagnosis, and there is little evidence to guide treatment until now [ 14 ]. No prospective data on how to manage those patients are comprehensively available; in general, however, we should follow the standard guidelines for treatment of metastatic breast cancer [ 9 ].…”