Dermatologic sequelae of breast cancer: From disease, surgery, and radiation

Abstract

The care of breast cancer patients is important to dermatologists. Breast cancer’s initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation‐induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet’s syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy‐induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow‐up.

Radiation-irritated skin and hyperpigmentation may impact the quality of life of breast cancer patients after whole breast radiotherapy

“…Acute skin reaction is one of the most common adverse effects of radiation therapy. Redness, skin hotness, itching, edema, darkening, and desquamation(peeling of the skin), hyperpigmentation are its clinical features [5][6][7]. The severity of acute radiation dermatitis ranges from mild erythema to wet desquamation and even ulceration.…”

RISREAC Study: Assessment of Cutaneous Radiation Injury Through Clinical Documentation

“…Although there are many possibilities for this observed difference in RD severity, the difference is most likely due to the lack of accounting for hyperpigmentation in clinical reporting of RD grade (ie, RTOG/ CTCAE score). [17][18][19] Clinicians reported Grade 0/Normal even if they documented hyperpigmentation. The under-recognition of hyperpigmentation as a symptom of RD impacts RD management in skin of color.…”

Kutane Sarkome – nicht alle sind wirklich selten, die meisten „low risk“

“…Die Erkrankung tritt im Bestrahlungsfeld 5-6 Jahre nach der Behandlung auf, wurde aber auch bis zu 41 Jahre nach Beendigung der Bestrahlung gesehen. Objektiv sind im bestrahlten Areal wieder hämatomartige Verfärbungen wegweisend noch bevor konsistenzvermehrtes Gewebe tastbar wird, zum Diagnosezeitpunkt sind die Tumoren meist schon um mehr als 5 cm groß [29,30]. Die wesentlich häufigeren benignen teleangiektatischen Ery-theme und sog.…”