Cutaneous metastasis of a breast cancer diagnosed 13 years before

Abstract

Metastasis is defined as a neoplastic lesion originating from another primary tumor, with which it is no longer in contact. Cutaneous metastases result from lymphatic embolization, hematogenous or contiguous dissemination or also direct implantation during surgical procedures. In women, the tumor most likely to metastasize to skin is breast cancer, which may manifest as papulonodular neoplastic lesions. We report the case of a 66 years old female patient, presenting papulonodular lesions13 years after the initial treatment with surgery and chemotherapy for a cancer of the left breast.

Cutaneous manifestations of breast cancer

“…Skin metastases occur in 0.7-10.4% of patients with cancer diagnosis, even though they account for only 2% of all skin cancers [8,9] (Table 1). The most common cancer types metastasizing to the skin include breast, ovarian, colorectal and lung cancer in women, and lung, colon and oral cancer in men [5].…”

“…However, it needs to be noted that breast cancer, particularly of the hormone-sensitive type, is characterized by a long-term tendency to relapse (2-5% risk of relapse even 20 years after surgery). Usually when skin metastases are found, imaging studies provide evidence for the involvement of other distant organs, which is an indicator of poor prognosis [8], though there are also breast cancer variants which, despite the presence of infiltration and/or skin metastases, do not metastasize to other organs for a long time. Most metastatic skin lesions are located on the chest, and the least common locations include the urogenital area and the face.…”

“…Most metastatic skin lesions are located on the chest, and the least common locations include the urogenital area and the face. The site of metastasis may be indicative of tumour origin: metastases developing on the skin of the chest, scalp and eyelids may suggest that the primary site of cancer is the breast [4,8,10,11]. Clinically, lesions are either uni-or multifocal, and present as hard pink-coloured nodules with possible ulceration [4,7,10].…”

“…Przerzuty do skóry występują u 0,7-10,4% pacjentów, u których zdiagnozowano raka, chociaż stanowią one tylko 2% wszystkich nowotworów skóry [8,9] (tab. 1).…”

“…Należy jednak zaznaczyć, że rak piersi, zwłaszcza o typie "hormonowrażliwym", charakteryzuje się długim okresem zdolności do nawracania (2-5-procentowe ryzyko nawrotu nawet 20 lat po operacji). Zazwyczaj, gdy w skórze obecne są przerzuty, w badaniach obrazowych stwierdza się zajęcie także innych narządów odległych i jest to oznaką złego rokowania [8]. Warto jednak pamiętać, że istnieją takie postacie raka piersi, które mimo obecności nacieku i/lub przerzutów w skórze długo nie dają przerzutów do innych narządów.…”