A narrative review of cutaneous manifestations and imaging landmarks of breast cancer
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Faculty of Medicine and Pharmacy, Dunarea de Jos University, Galati, ROMANIA
Emergency County Hospital “Sf. Apostol Andrei” Galati, Galati, ROMANIA
Clinical Infectious Diseases Hospital Galati, Galati, ROMANIA
Carol Davila University of Medicine and Pharmacy, Bucuresti, ROMANIA
Publication date: 2024-01-16
Electron J Gen Med 2024;21(1):em566
Breast cancer is the most prevalent form of malignancy among women worldwide. Breast cancer can emerge on the skin in two ways: directly, as skin metastases or a direct extension of the tumor; or indirectly, as a paraneoplastic disease. Breast cancer imaging is an essential part of breast cancer screening, diagnosis, preoperative/treatment assessment, and follow-up. The selection of optimal imaging modalities should be contingent upon the patient’s risk factors and breast density since breast cancer imaging necessitates a personalized approach rather than a universal solution. There are a lot of different skin conditions that point to breast cancer, either as a sign of recurring disease, undiagnosed breast cancer, or a condition that puts you at a higher risk of getting it. Even though reconstruction has been shown to improve quality of life for many women, there are still a lot of complicated factors that affect morbidity and results.
National Cancer Institute. National cancer stat facts: Female breast cancer. Available at: (Accessed: 7 November 2023).
Duggan C, Trapani D, Ilbawi AM, et al. National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: A population-based analysis. Lancet Oncol. 2021;22(11):1632-42. PMid:34653370.
Harbeck N, Penault-Llorca F, Cortes J, et al. Breast cancer. Nat Rev Dis Primers. 2019;5(1):66. PMid:31548545.
Cardoso F, Paluch-Shimon S, Senkus E, et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol. 2020;31(12):1623-49.
Fietz T, Tesch H, Rauh J, et al. Palliative systemic therapy and overall survival of 1,395 patients with advanced breast cancer–Results from the prospective German TMK cohort study. Breast. 2017;34:122-30. PMid:28586735.
Gobbini E, Ezzalfani M, Dieras V, et al. Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort. Eur J Cancer. 2018;96:17-24. 1016/j.ejca.2018.03.015 PMid:29660596.
Deluche E, Antoine A, Bachelot T, et al. Contemporary outcomes of metastatic breast cancer among 22,000 women from the multicentre ESME cohort 2008-2016. Eur J Cancer. 2020;129:60-70. PMid:32135312.
Menes TS, Coster D, Coster D. Contribution of clinical breast exam to cancer detection in women participating in a modern screening program. BMC Womens Health. 2021; 21(1):368. PMid:34666735 PMCid:PMC8524962.
Niell BL, Freer PE, Weinfurtner RJ, et al. Screening for breast cancer. Radiol Clin North Am. 2017;55(6):1145-62. PMid:28991557.
Schünemann HJ, Lerda D, Quinn C, et al. Breast cancer screening and diagnosis: A synopsis of the European breast guidelines. Ann Intern Med. 2020;172(1):46-56. PMid:31766052.
Stefanopol IA, Baroiu L, Neagu AI, et al. Clinical, imaging, histological and surgical aspects regarding giant paraovarian cysts: A systematic review. Ther Clin Risk Manag. 2022;18:513-22. PMid:35516165 PMCid:PMC9064068.
Moy L, Heller SL, Bailey L, et al. ACR appropriateness criteria(®) palpable breast masses. J Am Coll Radiol. 2017; 14(5S):S203-24. PMid:28473077.
Vasile CI, Vasile MC, Zlati ML, et al. Post COVID-19 infection psychosis: Could SARS-CoV-2 virus infection be a neuropsychiatric condition that triggers psychotic disorders?–A case-based short review. Infect Drug Resist. 2022;15:4697-705. PMid:36034176 PMCid:PMC9416515.
D’Orsi CJ SE, Mendelson EB, Morris EA, et al. ACR BI-RADS atlas, breast imaging reporting and data system. Reston, (VA): American College of Radiology; 2013.
Ikeda D, Miyake KK. Breast imaging: The requisites. St. Louis (MI): Elsevier; 2017.
Steyerova P, Burgetova A. Current imaging techniques and impact on diagnosis and survival–A narrative review. Ann Breast Surg. 2021;6.
Hooley RJ, Scoutt LM, Philpotts LE. Breast ultrasonography: State of the art. Radiology. 2013; 268(3):642-59. PMid:23970509.
American College of Radiology. ACR practice parameter for the performance of contrast-enhanced magnetic res- onance imaging (MRI) of the breast. Available at: (Accessed: 7 November 2023).
Mann RM, Cho N, Moy L. Breast MRI: State of the art. Radiology. 2019;292(3):520-36. PMid:31361209.
Plana MN, Carreira C, Muriel A, et al. Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: Systematic review of diagnostic accuracy and meta-analysis. Eur Radiol. 2012;22(1):26-38. PMid:21847541.
Bick U, Trimboli RM, Athanasiou A, et al. Image-guided breast biopsy and localisation: Recommendations for informa- tion to women and referring physicians by the European Society of Breast Imaging. Insights Imaging. 2020;11(1):12. PMid:32025985 PMCid:PMC7002629.
Spencer PS, Helm TN. Skin metastases in cancer patients. Cutis. 1987;39(2):119-21.
Krathen RA, Orengo IF, Rosen T. Cutaneous metastasis: A meta-analysis of data. South Med J. 2003;96(2):164-7. PMid:12630642.
Brownstein MH, Helwig EB. Metastatic tumors of the skin. Cancer. 1972;29(5):1298-307.<1298::AID-CNCR2820290526>3.0.CO;2-6 PMid:4336632.
Wong CY, Helm MA, Kalb RE, Helm TN, Zeitouni NC. The presentation, pathology, and current management strategies of cutaneous metastasis. N Am J Med Sci. 2013; 5(9):499-504. PMid:24251266 PMCid:PMC3818821.
Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol. 1990; 22(1):19-26. PMid:2298962.
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):228-36. PMid:8335743.
De Giorgi V, Grazzini M, Alfaioli B, et al. Cutaneous manifestations of breast carcinoma. Dermatol Ther. 2010;23(6):581-9. PMid:21054704.
Mordenti C, Peris K, Concetta Fargnoli M, et al. Cutaneous metastatic breast carcinoma. Acta Dermatovenerologica. 2000;9(4):143-8.
Nwabudike LC, Tatu AL. Magistral prescription with silver nitrate and peru balsam in difficult-to-heal diabetic foot ulcers. Am J Ther. 2018;25(6):e679-80. PMid:28614088.
Mullinax K, Cohen JB. Carcinoma en cuirasse presenting as keloids of the chest. Dermatol Surg. 2004;30(2 Pt 1):226-8. PMid:14756657.
Carlesimo M, Rossi A, De Marco G, et al. Carcinoma en cuirasse of the breast. Eur J Dermatol. 2009;19:289-0. PMid:19557891.
Mallon E, Dawber RP. Alopecia neoplastica without alopecia: A unique presentation of breast carcinoma scalp metastasis. J Am Acad Dermatol. 1994;31(2 Pt 2):319-21. PMid:8034796.
Valencia IC, Colsky A, Berman B. Multicentric reticulohistiocytosis associated with recurrent breast carcinoma. J Am Acad Dermatol. 1998;39(5 Pt 2):864-6. PMid:9810917.
Bennàssar A, Mas A, Guilabert A, Julià M, Mascaró-Galy JM, Herrero C. Multicentric reticulohistiocytosis with elevated cytokine serum levels. J Dermatol. 2011;38(9):905-10. PMid:21658110.
Gore M, Winters ME. Erythema gyratum repens: A rare paraneoplastic rash. West J Emerg Med. 2011;12(4):556-8. PMid:22224159 PMCid:PMC3236141.
Niculet E, Bobeica C, Tatu AL. Glucocorticoid-induced skin atrophy: The old and the new. Clin Cosmet Investig Dermatol. 2020;13:1041-50. PMid:33408495 PMCid:PMC7779293.
Pectasides D, Koumpou M, Gaglia A, et al. Dermatomyositis associated with breast cancer. Anticancer Res. 2006;26:2329-31.
Sandhu NP, Zakaria S, Degnim AC, Boughey JC. Dermatomyositis presenting as a paraneoplastic syndrome due to underlying breast cancer. BMJ Case Rep. 2011;2011:bcr1020103416. PMid:22714621 PMCid:PMC3062365.
Richardson JB, Callen JP. Dermatomyositis and malignancy. Med Clin North Am. 1989;73(5):1211-20. PMid:2671542.
Vulink AJE, ten Bokkel Huinink D. Acquired hypertrichosis lanuginosa: A rare cutaneous paraneoplastic syndrome. J Clin Oncol. 2007;25(12):1625-6. PMid:17443005.
Pilarski R, Burt R, Kohlman W, et al. Cowden syndrome and the PTEN hamartoma tumor syndrome: Systematic review and revised diagnostic criteria. J Natl Cancer Inst. 2013;105(21):1607-16. PMid:24136893.
National Comprehensive Cancer Network. Genetic/familial high-risk asssessment: Breast and ovarian. Available at: (Accessed: 7 November 2023).
Rojas K, Stuckey A. Breast cancer epidemiology and risk factors. Clin Obstet Gynecol. 2016;59(4):651-72. PMid:27681694.
Souto LRM. Invited discussion on: The impact of reconstructive modality and postoperative complications on decision regret and patient-reported outcomes. Aesthetic Plast Surg. 2022;46(2):661-6. PMid:35031824.
Boccola MA, Savage J, Rozen WM, et al. Surgical correction and reconstruction of the nipple-areola complex: Current review of techniques. J Reconstr Microsurg. 2010;26(9):589-600. PMid:20721849.
Butler PD, Plana NM, Hastings AL. Finishing touches: Expanding access to nipple-areola tattooing as a component of postmastectomy breast reconstruction. Plast Reconstr Surg Glob Open. 2019;7(11):e2558. PMid:31942320 PMCid:PMC6908362.
Stolier AJ, Sullivan SK, Dellacroce FJ. Technical considerations in nipple-sparing mastectomy: 82 consecutive cases without necrosis. Ann Surg Oncol. 2008;15(5):1341-7. PMid:18256883.
Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg. 2014;149(3):267-74. PMid:24429935.
van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: A population-based study. Lancet Oncol. 2016;17(8):1158-70. PMid:27344114.
Hartmann-Johnsen OJ, Kåresen R, Schlichting E, Nygård JF. Survival is better after breast conserving therapy than mastectomy for early stage breast cancer: A registry-based follow-up study of Norwegian women primary operated between 1998 and 2008. Ann Surg Oncol. 2015;22(12):3836-45. PMid:25743325 PMCid:PMC4595537.
Corradini S, Bauerfeind I, Belka C, et al. Trends in use and outcome of postoperative radiotherapy following mastectomy: A population-based study. Radiother Oncol. 2017;122(1):2-10. PMid:27641786.
Gu J, Groot G, Holtslander L, Engler-Stringer R. Understanding women’s choice of mastectomy versus breast conserving therapy in early-stage breast cancer. Clin Med Insights Oncol. 2017;11:1179554917691266. PMid:28469511 PMCid:PMC5395266.
Lee WQ, Tan VKM, Choo HMC, et al. Factors influencing patient decision-making between simple mastectomy and surgical alternatives. BJS Open. 2018;3(1):31-7. PMid:30734013 PMCid:PMC6354187.
Shaverdian N, Wang X, Hegde JV, et al. The patient’s perspective on breast radiotherapy: Initial fears and expectations versus reality. Cancer. 2018;124(8):1673-81. PMid:29479673.
Agarwal S, Agarwal S, Neumayer L, Agarwal JP. Therapeutic nipple-sparing mastectomy: Trends based on a national cancer database. Am J Surg. 2014;208(1):93-8. PMid:24581994.
Sisco M, Kyrillos AM, Lapin BR, Wang CE, Yao KA. Trends and variation in the use of nipple-sparing mastectomy for breast cancer in the United States. Breast Cancer Res. Treat. 2016;160(1):111-20. PMid:27620883.
Li M, Chen K, Liu F, Su F, Li S, Zhu L. Nipple sparing mastectomy in breast cancer patients and long-term survival outcomes: An analysis of the SEER database. PLoS One. 2017;12(8):e0183448. PMid:28841691 PMCid:PMC5571910.
Poortmans, PMP, Arenas M, Livi L. Over-irradiation. Breast. 2017;31:295-302. PMid:27522160.
Matros E, Shamsunder M, Disa JJ. The effect of the breast cancer provider discussion law on breast reconstruction rates in New York State. Plast Reconstr Surg. 2019;144(3): 569-70. PMid:31461003 PMCid:PMC6755661.
Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: Results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. 2017;35(22):2499-506. PMid:28346808 PMCid:PMC5536162.
Nguyen AT, Chang DW. Discussion: A paradigm shift in U.S. breast reconstruction: Increasing implant rates. Plast Reconstr Surg. 2013;131(1):24-5. PMid:23271516.
Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: Increasing implant rates. Plast Reconstr Surg. 2013;131(1):15-23. PMid:23271515.
Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish breast cancer cooperative group 82b trial. N Engl J Med. 1997;337(14):949-55. PMid:9395428.
Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish breast cancer cooperative group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641-8. PMid:10335782.
EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: Metaanalysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127-35.
Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337(14):956-62. PMid:9309100.
Frasier LL, Holden S, Holden T, et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in national comprehensive cancer network guidelines. JAMA Oncol. 2016;2(1):95-101. PMid:26539936 PMCid:PMC4713236.
Poppe MM, Agarwal JP. Breast reconstruction with postmastectomy radiation: Choices and tradeoffs. J Clin Oncol. 2017;35(22):2467-70. PMid:28481705.
Alderman AK, Wilkins EG, Kim HM, et al. Complications in postmastectomy breast reconstruction: Two-year results of the Michigan breast reconstruction outcome study. Plast Reconstr Surg. 2002;109(7):2265-74. PMid:12045548.
Benediktsson K, Perbeck L. Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and nonirradiated breast cancer patients: Five years of monitoring of a prospective trial. J Plast Reconstr Aesthet Surg. 2006;59(1):27-34. PMid:16482787.
Whitfield GA, Horan G, Irwin MS, et al. Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 gray in 15 fractions. Radiother Oncol. 2009;90(1):141-7. PMid:18977547.
Christante D, Pommier SJ, Samuelson BT, et al. Using complications associated with postmastectomy radiation and immediate breast reconstruction to improve surgical decision making. Arch Surg. 2010;145(9):873-8. PMid:20855758.
Fowble B, Park C, Wang F, et al. Rates of reconstruction failure in patients undergoing immediate reconstruction with tissue expanders and/or implants and postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys.2015;92(3):634-41. PMid:25936815.
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