The breast is composed of glands that produce milk called lobules, thin tubes known as ducts that transport milk from the lobules to the nipple, and fatty and connective tissues that surround lymph nodes and blood vessels called stroma. Breast cancer is a malignant disease that affects any part of the breast, and is related to an uncontrolled growth of cells.

Breast cancer can afflict both men and women. However, it is the second most common type of cancer among women and a rare disease among men, with skin cancer being the most common in both genders. According to the American Cancer Society, there are about 246,600 new cases of breast cancer in women, and about 2,500 new cases in men, every year in the U.S.

Nipple or Breast Skin Alterations as a Symptom of Breast Cancer

Women may experience alterations in the skin of their breast, including the nipple and areola. This may be caused by a number of benign conditions, but also by breast cancer. Nipple or breast skin alterations related to cancer include redness (erythema), irritation, partial thickening of the skin, a texture similar to an orange (peau d’orange), dimpling of the tissue, or alteration of the color of the skin to pink, reddish-purple, or bruised. Alterations may also occur in the nipple, including nipple retraction, thickening or redness/scaliness, pain, or an abnormal nipple discharge other than breast milk. Nipple or breast skin alterations are related to a buildup of fluid in the skin of the breast due to a blockage in the skin’s lymph vessels, which disrupts the normal flow of lymph through the tissue.  In addition, treatments like chemotherapy can also result in skin alterations, making skin more dry, flaky, or sensitive to exposure to sun, wind, and other elements.

Rare subtypes of breast cancer can cause skin alterations, which can be mistaken for and initially diagnosed as an infection. To confirm the diagnosis, physicians ask about the patient’s medical history, perform a full physical examination, and request exams like imaging X-rays, a mammogram, a breast ultrasound, a magnetic resonance imaging (MRI) of the breast, or a biopsy. Other tests that may also be needed include a nipple discharge exam, a ductal lavage and nipple aspiration, and a fine needle aspiration (FNA).

Skin Alterations and Inflammatory Breast Cancer

Nipple or breast skin alterations are most commonly associated with inflammatory breast cancer. “Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival,” the American Cancer Society says.

Numerous treatments are included in a multimodal approach, according to the Cancer Society, such as neoadjuvant chemotherapy, which is used before a surgery and may include the administration of anthracyclines and taxanes, divided into six cycles for about four to six months. Targeted therapy is another possibility, and it consists of using an anti-HER2 drug like trastuzumab (Herceptin) to address the HER2 protein, which is produced in large amounts and promotes cancer growth. Hormone therapy is used when the tumor has hormone receptors, and drugs often used include tamoxifen and aromatase inhibitors such as letrozole. When patients undergo surgery, the most common procedure is a radical mastectomy, followed by post-mastectomy radiation therapy to the chest wall under the breast that was removed. Other common adjuvant, or post-surgery, therapies consist of chemotherapy, hormone therapy, targeted therapy, or a combination of treatments, to decrease the risk of cancer recurrence.

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