Carcinoma En Cuirasse Presenting as Keloids of the Chest

Abstract

Unusual keloid-like nodules or scars on the chest that fail to respond to therapy may be primary or metastatic malignancies, and adequate histologic verification should be obtained to avoid delay in the proper treatment.

Breast carcinoma en cuirasse as a natural progression of untreated breast cancer

“…These papules and nodules then coalesce into a thickened, leathery, plate-like mass of indurated plaques without associated inflammation that may be pruritic, painful, bleeding, or have foul-smelling discharge. [1,3,4,6] In addition to the typical presentation, breast carcinoma en cuirasse has also been reported to present in unusual manners such as keloids of the chest [6,7] or with zosteriform metastasis.…”

“…Treatment modalities that have been used include intra-lesional chemotherapy, radiotherapy, hormonal antagonists or HER2-targeted therapies depending on receptor expression, and even snake venom. [6,8] Unlike inflammatory breast cancer which begins in the breast ducts and then spreads to and remains contiguous with the skin, breast carcinoma en cuirasse is an actual metastasis of breast carcinoma to the skin. Given the lack of a definitive cure when in an advanced state, and difficulty of treatment for breast carcinoma en cuirasse, most patients are treated symptomatically or with palliative care, and usually succumb to local complications such as infection or to distant metastases.…”

“…[1][2][3][4][5] Lookingbill et al showed that breast cancer was the most common malignancy with breast cancer alone accounting for 51% of all cases of patients with cutaneous metastases from metastatic carcinoma, and 73% of all cases in women. [2] Carcinoma en cuirasse, also known as scirrhous carcinoma, pachydermia, Acarcine eburnee, [6] is a type of cutaneous metastases with a distinctive clinical presentation. It typically starts with swelling, pitting edema, and scattered, firm papules and nodules overlying an erythematous breast.…”

“…[1,3,4,6] Pathologically, it is seen across all receptor subtypes. Given the rarity of this disease, no pathological marker is known.…”

Carcinoma en cuirasse with Zosteriform Metastasis-A Rare Presentation of Breast Carcinoma

“…This may be explained on the basis of perineural involvement of nerves. Induration could be related to chronic lymphatic obstruction as proposed by Hanley [6]. It is of diagnostic importance as it may be first manifestation of an unknown primary malignancy or first indication of metastasis of treated malignancy.…”