Objective: The present report aims to describe a case of invasive ductal carcinoma in a young patient. Methodology: Active search in medical records. Case: B.S.M., female, 18 years old, arrived at the oncology service with diagnosed ductal infiltrative carcinoma, with a tumor measuring 6 x 8 cm, staging T4 Nx M1, with metastasis to lungs, and marker level CA 15-3 was 9,2, 4 months ago. The histopathology presented the carcinoma was moderately differentiated with intraductal component associated and the immunohistochemistry shows 95% for both estrogen and progesterone receptors, negative for HER-2 and level of 20% for Ki-67, both of them from 5 months ago. The thoracic CT from 4 months ago showed many non-calcified nodules sparse in pulmonary parenchyma up to 14 mm, compatible with implants, increased density in retroareolar region measuring 39 x 34 mm with slight thickening of adjacent skin, two nodules of 5 mm each and axilary limph nodes up to 11mm. At physical examination, the tumor was compromising 70% of the right breast, which was presenting nipple retraction and ulceration. Palliative chemotherapy was initiated with Fluoracil, Doxorubicin and Cyclophosphamide (FAC) once 4 months ago (11/21/17), that was switched to Doxorubicin, Cyclphosphamide and Paclitaxel (AC-T) for unavailability of Fluoracil at the Institution. The patient was submitted to 3 sessions of FAC 3 months ago (01/22/18). At 02/16/18, at physical examination right breast presented a tumor sized 7 x 6 with nipple ulceration, demonstrating fail of treatment, and then was administered the first cycle of Docexatel. At physical examination at 03/09/18, right breast presented a tumor of 5 x 5 cm with nipple injure on healing phase and the patient was conducted to the second cycle of Docexatel. Considerations: Breast cancer is considered rare before the age of 35, and the risk of having it grows rapidly with age, with its apex appearing between 40 and 60 years. The patient of the case for being 18 years of age demonstrates an exception to the age values in the statistical data. Thus, new studies are needed to understand the appearance of breast cancer in young patients.

The Köebner phenomenon is characterized by the appearance of several types of dermatological lesions after traumatic stimulation. The triggering of this phenomenon after breast surgery is uncommon and usually associated with psoriatic lesions. The aim of this study was to describe two cases of vitiligo as the initial manifestation of Köebner phenomenon after breast oncoplastic surgery. Case 1: female, 41 years old, no history of dermatological pathologies, presenting with tubular carcinoma in the right breast. Quadrantectomy and sentinel lymph node biopsy were performed, followed by reconstruction with mammoplasty. Later, the patient started on tamoxifen and underwent radiotherapy, without complications. Thirty days after treatment, the patient presented progressive depigmentation of the areola-papillary complex. Topical treatment was started with dermatological ointment tacrolimus monohydrate and, after one year, the condition was completely resolved. Case 2: 52-yearold woman with previous history of vitiligo on the face, with complete clinical response after dermatological treatment. She was diagnosed with ductal carcinoma in situ on the left breast and underwent quadrantectomy, by means of mammoplasty using the round block technique. Afterwards, she underwent radiotherapy and started tamoxifen. Four years after the surgery, she developed dyschromia in the ipsilateral periareolar region and was diagnosed with vitiligo. Local dermopigmentation was offered, but the patient opted for an expectant conduct and clinical follow-up. To our knowledge, this is the first description of Köebner phenomenon after breast oncoplastic surgery. In these cases, the therapeutic approach must be multidisciplinary and count on the assessment of multiple clinical and individual parameters.