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FEATURE ARTICLE
Cutaneous Metastatic Breast Cancer
Susan Moore, RN, MSN, APN-NP, AOCN ®
reast cancer is the most
Pathophysiology
commonly diagnosed
Breast cancer is the most commonly diagnosed cancer in
Cutaneous metastatic skin lecancer in women and the
women and the second leading cause of cancer deaths
sions are extensions of tumors to
second leading cause of cancer
among women in the United States. Many women diagthe skin, preferentially occurring
deaths among women in the
in the skin overlying or proximal
nosed with breast cancer will achieve a cure with surgery
United States. Estimates for
to the primary tumor. Most com2002 indicate that nearly
followed by adjuvant chemotherapy, hormonal therapy, or
monly, breast cancer metastasis to
203,500 new cases of breast canradiation therapy; however, some breast cancer survivors
the skin occurs via direct extencer will be diagnosed and 39,600
will develop locally recurrent disease. Skin metastases are
sion or through vascular or lymwomen will die from the disease
phatic channels. Other mecha(Jemal, Thomas, Murray, &
one of the most distressing presentations of locally recurnisms include iatrogenic implanThun, 2002). Many women dirent breast cancer. The purpose of this article is to intation of malignant cells followagnosed with breast cancer will
crease oncology nurses’ understanding of the pathophysiing a surgical procedure, such as
achieve a cure through surgery
mastectomy or reconstruction.
followed by adjuvant chemoology of cutaneous metastases, facilitate recognition of
The appearance of cutaneous metherapy, hormonal therapy, or
the various presentations of cutaneous metastatic breast
tastases in breast cancer is generradiation therapy (RT). Some
cancer, discuss management of both the underlying disally a late sign, although cutanebreast cancer survivors will deease process and skin lesions, and identify issues of psyous metastases may be the prevelop locally recurrent disease
senting sign of an undiagnosed,
defined as “any reappearance of
chosocial support for patients and families throughout the
asymptomatic breast cancer. Cucancer in the ipsilateral breast,
continuum of illness.
taneous metastases of breast canchest wall, or skin overlying the
cer generally are found on the
chest wall after initial therapy”
(Recht, Come, Troyan, & Sadowsky, 2000,
The skin is a common site for the spread of chest, abdomen, and scalp; less frequently on
p. 731).
internal malignancies, and nearly half of ob- the back, upper arms, and lower abdomen; and
One of the most distressing presentations served skin metastases in patients with can- rarely on the buttocks, perianal region, lower
of locally recurrent breast cancer is the ap- cer are because of progression of breast can- extremities, and eyelids (Schwartz, 1995).
Several types of cutaneous metastases are
pearance of cutaneous metastases. After cer (Crosby, 1998). Cutaneous metastases can
melanoma, breast cancer is the most com- occur following breast-conserving treatment unique to breast cancer. Carcinoma erysipemon cancer to metastasize to the skin (Mor- (BCT), which consists of lumpectomy fol- latoides is found generally in patients with indenti, Peris, Fargnoli, Cerroni, & Chimenti, lowed by RT or mastectomy, even if postsur- flammatory breast cancer and is the most
2000). The presence of skin metastases is a gical RT was delivered to the chest wall. Lo- common situation in which skin metastasis is
daily, visible reminder of the disease. Dis- cal recurrence in the skin of the treated breast the presenting sign of the underlying cancer.
ruption of the integumentary barrier can be- is rare following BCT and dependent on many The lesions generally are rash-like, warm, tencome infected and result in open, bleeding variables, such as nodal status or tumor size. der, and erythematous, they often are elevated
wounds that are difficult to control. The In a study of 1,624 patients who underwent above the skin surface, and they usually have
purpose of this article is to increase oncol- BCT, skin recurrence without parenchymal a distinctive leading edge (see Figure 1). The
ogy nurses’ understanding of the patho- involvement was observed in 1.1% of patients
physiology of cutaneous metastases, facili- (Gage et al., 1998). Local recurrence after
tate recognition of the various presenta- mastectomy has a reported incidence of 6% Submitted January 2002. Accepted for pubtions of cutaneous metastatic breast cancer, (Roses, 1999). Approximately 90% of local lication March 6, 2002. (Mention of specific
discuss management of both the underly- recurrences appear within five years follow- products and opinions related to those proding disease process and skin lesions, and ing mastectomy and nearly 100% occur by ucts do not indicate or imply endorsement by
identify issues of psychosocial support for 10 years, although recurrences as long as 50 the Clinical Journal of Oncology Nursing or
patients and their families throughout the years after initial diagnosis have been reported the Oncology Nursing Society.)
continuum of illness.
Digital Object Identifier: 10.1188/02.CJON.255-260
(Recht et al., 2000).
B
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 6, NUMBER 5 • CUTANEOUS METASTATIC BREAST CANCER
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