Cutaneous Metastases in Breast Cancer
Cutaneous metastases occur more often in breast cancer than in other diseases in women. Presentation often is ambiguous because the metastases can mimic other common processes (e.g., cellulitis, lymphedema). Accurate differential diagnosis identifies less obvious manifestations of progressive disease and allows for appropriate management. Although interventions are aimed at halting disease progression, cutaneous metastases indicate an incurable diagnosis. Treatment focuses on delaying progressive disease, controlling symptoms, and maintaining quality of life. The care of skin metastases evolves as the tumor spreads and more tissue destruction occurs. Skin management and topical interventions increase comfort, decrease distress, and create feelings of control in this population.
Metastatic cutaneous lesions are seen more commonly in breast cancer than in any other malignancy in women, exceeding 20% of all cutaneous metastases (Nava, Greer, Patterson, & Lin, 2009; Schwartz, Wiederkehr, & Lambert, 2004). Cutaneous metastases indicate that the underlying tumor has infiltrated into the skin, blood capillaries, and lymph vessels (Lund-Nielson, Muller, & Adamsen, 2005). The presence of skin metastases signifies widespread systemic disease and a poor prognosis (Hussein, 2010). Median survival time varies. A mean survival of 57.43 months for breast cancer with cutaneous only metastases was reported in a retrospective series by Hu, Chen, Lu, Wu, and Lan (2008). Median overall survival in metastatic breast cancer is about 36 months (Pal et al., 2008). Cutaneous breast metastases most commonly present on the chest wall. The abdomen, back, head and neck, scalp, and upper extremities also are common sites (Hu et al., 2008; Hussein, 2010) (see Figure 1).
(Enlarge Image)
Figure 1.
Skin (Cutaneous) Metastasis on the Lower Back
Note. Copyright 2011 by Jack Jerjian/Phototake. All rights reserved. Used with permission.
Assessment of cutaneous metastatic disease can be perplexing because the clinical presentation appears similar to other skin maladies such as cellulitis or lymphedema (Schwartz et al., 2004). Patients present with a variety of symptoms ranging from firm, indurated skin to tiny, seed-like solid papules and large egg-sized lesions (Hussein, 2010; Nashan et al., 2009). Treatment is driven by two goals: (a) improving survival through gaining control of the disease and (b) optimizing quality of life and symptom management.
Abstract and Introduction
Introduction
Cutaneous metastases occur more often in breast cancer than in other diseases in women. Presentation often is ambiguous because the metastases can mimic other common processes (e.g., cellulitis, lymphedema). Accurate differential diagnosis identifies less obvious manifestations of progressive disease and allows for appropriate management. Although interventions are aimed at halting disease progression, cutaneous metastases indicate an incurable diagnosis. Treatment focuses on delaying progressive disease, controlling symptoms, and maintaining quality of life. The care of skin metastases evolves as the tumor spreads and more tissue destruction occurs. Skin management and topical interventions increase comfort, decrease distress, and create feelings of control in this population.
Metastatic cutaneous lesions are seen more commonly in breast cancer than in any other malignancy in women, exceeding 20% of all cutaneous metastases (Nava, Greer, Patterson, & Lin, 2009; Schwartz, Wiederkehr, & Lambert, 2004). Cutaneous metastases indicate that the underlying tumor has infiltrated into the skin, blood capillaries, and lymph vessels (Lund-Nielson, Muller, & Adamsen, 2005). The presence of skin metastases signifies widespread systemic disease and a poor prognosis (Hussein, 2010). Median survival time varies. A mean survival of 57.43 months for breast cancer with cutaneous only metastases was reported in a retrospective series by Hu, Chen, Lu, Wu, and Lan (2008). Median overall survival in metastatic breast cancer is about 36 months (Pal et al., 2008). Cutaneous breast metastases most commonly present on the chest wall. The abdomen, back, head and neck, scalp, and upper extremities also are common sites (Hu et al., 2008; Hussein, 2010) (see Figure 1).
(Enlarge Image)
Figure 1.
Skin (Cutaneous) Metastasis on the Lower Back
Note. Copyright 2011 by Jack Jerjian/Phototake. All rights reserved. Used with permission.
Assessment of cutaneous metastatic disease can be perplexing because the clinical presentation appears similar to other skin maladies such as cellulitis or lymphedema (Schwartz et al., 2004). Patients present with a variety of symptoms ranging from firm, indurated skin to tiny, seed-like solid papules and large egg-sized lesions (Hussein, 2010; Nashan et al., 2009). Treatment is driven by two goals: (a) improving survival through gaining control of the disease and (b) optimizing quality of life and symptom management.