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This material is protected by U.S. copyright law. Unauthorized reproduction is prohibited. To purchase quantity reprints, please e-mail [email protected] or to request permission to reproduce multiple copies, please e-mail [email protected]. 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 255