Skin metastases in breast cancer: a review article

Skin metastases from breast cancer usually occur in more advanced stages of the disease, but can sometimes be the first clinical manifestation of breast cancer or the first evidence of a previous tumor recurrence. These demonstrations significantly reduce survival. Skin metastases from breast cancer have different manifestations. The most common manifestations are nodules. These nodules are soft, round or oval, mobile, firm, and elastic in texture and can be single or multiple, often flesh-colored, but can also be brown, bluish black, and pink to reddish brown. In the absence of a previous history of cancer, it can be difficult to diagnose the early location of metastatic cancers. However, metastases usually show histopathological similarities to the primary tumor. Soft tissue breast metastases usually have a better prognosis than breast or bone cancer metastases. Also, skin metastases from breast cancer do not necessarily have a poor prognosis as skin metastases from other malignancies. The relative risk of death from skin metastases to other malignancies is more than four times higher than skin metastases from breast cancer. Differential diagnosis includes cutaneous lymphoma, intracranial leukocyte infiltration, and cutaneous metastasis. Metastatic skin lesions are often mistaken for benign lesions. Recognizing them quickly is important to prevent long-term anti-inflammatory treatment that delays proper diagnosis. Therefore, to rule out metastasis, abnormal or nodular lesions should be considered for biopsy in patients with a history of systemic malignancy or suspected malignancy. Cutaneous metastases are usually a sign of widespread disease and may not be treatable in most cases. Treatment options include systemic and/or topical treatments. Extensive skin metastases require systemic treatment. For thicker skin metastases, radiation therapy, surgical or electrochemical resection is indicated as monotherapy or in combination. Oxygen in combination with topical 5% methotrexate (OFAMTX, 5% methotrexate in a carrier solution) is a recently described method that facilitates drug penetration into the epidermis. In the absence of visceral or lymph node metastases, OFAMTX is useful as a local skin treatment. This treatment is an effective and tolerable method for superficial skin metastases. Using local treatment in combination with systemic agents increases the overall effectiveness of treatment on skin metastases.