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Inflammatory breast carcinoma is a rare type of breast cancer with an incidence of about 2 to 4% of breast cancer cases in the United States. In spite of its lower incidence, it does have higher mortality at 7% of breast cancer-related mortality.
When it occurs in the skin it can appear as redness or pink patches involving the skin of the breast. This may or may not have skin changes such as underlying induration or thickening of the skin. There is usually no underlying lump, nodule, or mass.
The cases that I have diagnosed have been a bit challenging in that the patients had not even considered breast cancer as a possibility. Actually most had thought the redness was a result of hives or other types of rashes. There was little convincing involved in the consideration of a biopsy as there is no underlying mass in many cases. It can be challenging for a patient to even consider this as a possibility. Often times I would have to outline the area and have the patient return in a couple of days to show or demonstrate that there is no fluctuation in the affected skin. Hives or other contact reactions will fluctuate or be somewhat dynamic in how they behave. This step helps these patients realize that there is a difference in behavior and appearance of the affected skin.
They are diagnostic criteria to meet for inflammatory breast carcinoma to be diagnosed. According to the American Joint Committee on Cancer (AJCC) the following criteria must be met.
Rapid onset of breast redness or erythema, swelling +/- dimpling of skin / p’eau d’orange skin changes, +/- warmth of breast skin, +/- underlying mass.
Duration for less than six months.
Erythema or redness occupying at least 1/3 of the breast.
Biopsy confirmation of carcinoma
According to the American Cancer Society, inflammatory breast carcinoma tends to occur in women younger than the age of 40. This is concerning as routine breast cancer screenings via mammography generally start after the age of 40.
According to the American Cancer Society, inflammatory breast carcinoma is more often seen in African-American women than in white women. This is also concerning to me as sometimes the subtle features that this type of breast cancer can present as initially may be difficult to recognize or diagnose. Palpation of the skin of the breast is essential to evaluate for any thickening or changes in the texture of the skin. Also recognizing that other features such as nipple inversion and the p’eau d’orange skin changes may be the clues needed to identify these cases. Unless there is an awareness to look for these changes it may be difficult to diagnose early.
All inflammatory breast carcinoma is stage III at diagnosis because it involves the skin at the time of diagnosis. If you are routinely having skin exams, but not yet having breast examinations by your gynecologist, it is important to point this out to your dermatologist so that examination of the skin of the breast can be included in your skin cancer screening. If you note any changes in the skin of the breast that are of concern to you, please point these out to your dermatologist so that a biopsy and further workup can be considered.
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