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Forum Name: Breast Cancer

Question: Rash: inflammatory breast cancer?


 pipsmum - Fri Jul 23, 2010 4:09 pm

I'm a 53 year old female, currently recovering from pelvic floor surgery, a result of which I'm now self catheterising,due to retention of urine. Approx 12 days ago, I had a stinging in the left breast, followed a day later by a rash made up of three small marks or spts, surrounded by a reddish area. My breasts are small, and this rash is about 1 inch from my nipple (above and to the right) and overs about an inch square. Around that time, I experienced a lot of pain when carrying my rucksack - in fact. I thought maybe I'd pulled a muscle. After taking cocodamol, this pain subsided, and I no longer carried the rucksack.
A week after the rash appeared, I checked with a GP. An infection was suggested and antibiotics given, with an appointment for review in 7 days. The rash is still there, 3 days after taking the drugs, and also using hydrocortisone cream. The breast is a litlle painful, and itches at times. Today, I noticed almost the same rash under the left shoulder blade. It may have been there all the time, but I only noticed it today, as it was uncomfortable.
Do you think this could be inflammatory breast cancer? I don't see the GP again for 4 days.
Thank you.
 Dr.M.Aroon kamath - Sat Jul 24, 2010 1:00 am

User avatar Hi,

A rash/redness over the breast can be caused by a wide variety of conditions, most of which will be benign.The fact that one type of aggressive breast cancer presents with features of "inflammation" of the skin overlying the breast mandates that in any "inflammatory"- like condition of the breast, a suspicion of inflammatory breast cancer(IBC) must be entertained and excluded.

Inflammatory breast cancer is usually seen in women at an average age of 59. Slightly more in black women compared to the white women. Also the affected women tend to be slightly younger than the average age at which other types of breast cancer usually present.

Inflammatory breast cancer rather unique in that there is no associated lump (as sometimes seen in other common forms of breast cancer)or suspicious parenchymal changes on routine screening mammograms- therefore prone to misdiagnosis and delayed presentations.

Some of the more common signs and symptoms are,

- fairly sudden increase in thickness, heaviness or visible enlargement of one breast,
- an 'inflammed' appearance of the skin overlying the breast,
- affected breast may feel unusually warm,
- an orange peel (peau d'orange) appearance of the skin,
- Itching(sometimes).
- mastalgia, tenderness,
- enlarged axillary, supraclavicular or infraclavicular lymph nodes(sometimes),
- inversion of nipple(sometimes).

An excisional biopsy that includes the skin is necessary for diagnosis (Tumor emboli in the lymphatic vessels of the skin are diagnostic).
Imaging tests - such as mammogram and breast ultrasonography also may be yield helpful information (to exclude other conditions and to demonstrate areas of skin thickening dur to inflammatory breast cancer).

In your case, other than this possibility,the more common benign lesions will need to be considered.Some of them are

- "mammary duct ectasia": Affects major breast ducts and is poorly understood.Duct ectasia mainly affects middle-aged to elderly parous women. Presents with noncyclical mastalgia, discharge from nipple, nipple retraction, a subareolar breast mass with or without overlying breast inflammation, a periareolar abscess, or in later stages, a mammillary fistula.Smoking is a risk factor( X 3 times that of non-smokers). The risk appears to be proportional to the duration of smoking.(your profile indicates that you have been a smoker for the past 14 years).
- "periductal mastitis" :very similar in most ways to mammary duct ectasia but affects younger women.Smoking once again is a risk factor.
- as you are complaining of a similar lesion under the left shoulder blade, this lends support to the possibility of this being a purely dermatological condition.

Although your concerns are well founded, your description favors either a purely dermatological problem or possibly a mammary duct ectasia.
Please do show to your GP soon and have yourself examined & tested. Best wishes!
 Dr.M.jagesh kamath - Sat Jul 24, 2010 2:08 am

User avatar Hello,A dermatologist opinion would be in favour of Herpes Zoster.Unilateral pain followed by painful rash.While you must think of all what Dr.Aroon kamath has touched upon,this diagnosis would be the most likely one.Early treatment is a must to prevent post herpetic neuralgias.
Cheers!
 pipsmum - Sat Jul 24, 2010 6:36 am

Thank you for your thoughtful and considered replies. Just to clarify five things:

I did smoke for approx 14 years, but have been a non-smoker for 25 years.
I had a total hysterectomy five years ago, and have been using oestrogen since then.
I started taking Plaquenil 3 plus weeks ago, however my GP didn't think it was a drugs rash.
Having Sjogren's, I am susceptible to skin rashes, but have not had anything like this before, and I've had vey little exposure to the sun.
Most important'y, in my anxiety, I didn't mention that a routine mammogram 4 weeks ago came back clear.

I would not like to ask another question, would the fact that I am using steroid nasal spray(Nasonex) make me more susceptible to the herpes simplex?

I really appreciate your taking the time to consider these factors.

Pipsmum
 Dr.M.jagesh kamath - Sat Jul 24, 2010 9:59 am

User avatar Hello,Herpes Zoster is different from simplex.This if so requiries you to start early treatment with Acyclovir to avoid complications like post herpetic neuralgias.So you must contact your doctor at the earliest, since it is imperative to start treatment.Rest can wait.ok?
 pipsmum - Sat Jul 24, 2010 1:10 pm

Thank you very much. I will speak with my GP as soon as possible. I wonder though, why they didn't suggest it was herpes zoster when I presented with the rash 5 days ago.
 Dr.M.jagesh kamath - Sun Jul 25, 2010 3:31 am

User avatar Hello,Zoster virus is indeed chicken pox virus which remains dormant in nerves.When there is loss of resistance the virus comes out.First there is pain on one side along the nerve root for a day or two then the rash which can encompass the whole side.This starts first papular and later water filled vesicles.Pain is a very important feature in some.
The medications work best in the first 48hrs and to prevent later complications of pain along nerve root.This is known as post herpetic neuralgia.
Ultimately this may be turn out to be drug rash or insect bite reaction but then the unilateral location and history lend support to H.Zoster.
With my best wishes.
 pipsmum - Sun Jul 25, 2010 5:15 am

Dr Jagesh

Thank you. I really appreciate your knowledge. My thinking now is, as I've gone way past the 48 hours, there should be no harm in waiting to see the GP in another 48 hours. To be honest, the rash doesn't look blistery, but maybe it's just atypical.

I will let you know what the GP says in due course.

Sincerely
Pipsmum
 Dr.M.jagesh kamath - Sun Jul 25, 2010 9:04 pm

User avatar Hello,I am happy it is settling down,may be nothing more than just a mild one.By the way it is very difficult to spot zoster early, even for a trained eye.Zoster sine herpete, is zoster with out a rash and just pain unilateral.
Cheers!
 pipsmum - Tue Jul 27, 2010 4:23 pm

Hi Dr Jagesh

The GP has confirmed that the rash is indeed shingles. Thank you so much for putting my mind at ease over the weekend. It's always such an anxious time, when you are concerned about health problems. The antibiotics that were mistakenly given seem to have helped my urinary retention too. It's nowhere near perfect, but it may be that it was being hindered by an infection.

Thank you for being part of such a marvelous team.

Pipsmum.
 Dr.M.jagesh kamath - Sun Aug 08, 2010 9:27 pm

User avatar Hello Pipsmum,Thank you for the kind words.My best wishes.

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