The histology of peau d’orange in breast cancer – what are the implications for surgery?

Abstract

Introduction. Surgery is sometimes performed on patients with peau d' orange (dermal oedema) of the breast. This may be done to achieve local control of cancer after neo-adjuvant chemotherapy or in resectable locally advanced disease. Conventional practice is not to place excision lines through areas of peau d' orange for fear of recurrence in such an area. The question can be asked whether this wisdom is still valid in modern practice. No formal cohort studies documenting the histopathology of the skin in areas of peau d' orange have been published, and available descriptions are scanty.Aim. To describe the histopathological features of peau d' orange. Method. Consecutive patients undergoing mastectomy for cancer in whom peau d' orange was present were selected over a period of 2 years. Blocks of skin were excised from areas of peau d' orange and examined histologically. The presence, nature and location of malignant cells were recorded and correlated with lymph node pathology. Prior administration of neo-adjuvant chemotherapy was noted.