Ulcerative Carcinoma of the Breast With Zosteriform Skin Metastases

Abstract

A 71-year-old deaf and mute woman was referred to our clinic for a "bad-smelling eruption of the trunk." On physical examination, the anterolateral portion of the left breast was markedly reduced with respect to the contralateral one, indurated at palpation, and covered by a thick mantle of fibrin and necrotic tissue (Fig. 1a). Moreover, the patient had numerous erythematous plaques, ulcerated nodules, and serohematic blisters localized in a zosteriform pattern on the homolateral aspect of the trunk (Fig. 1b).Incisional biopsy specimens and histologic examination confirmed that the left breast lesion was a carcinoma (ductal type, infiltrating, grade G2) and the other skin lesions were metastases. Cytologic examination and direct immunofluorescence assays performed on a blistering lesion were negative. All the clinical and laboratory assays that we performed in order to rule out any internal involvement were unrevealing except for hypochromic microcytic anemia and hypoalbuminemia. The neoplasm was staged as T4cN0M1 and palliative radiotherapy was started. At the 1 year follow-up, the patient was still alive without any apparent involvement of internal organs.The patient presented when the cancer had already invaded and destroyed the lower portion of the left breast, a "monstre" picture that is uncommon in developed countries. Clinical and laboratory investigations excluded the presence of internal metastases until 1 year after the diagnosis. Such a relatively benign disease course appeared very surprising, considering the local invasivity of the neoplasm. Breast cancer metastasization confined to distant skin areas is relatively rare. The presence of blisters made necessary the exclusion of other dermatoses. In particular, serologic and cytologic assays excluded the coexistence of herpes zoster, while direct immunofluorescence assay excluded localized bullous pemphigoid.Cutaneous metastases featuring a zosteriform pattern are rare in the literature. In these cases, the mechanism of dissemination is very often uncertain, although lymphatic or perineural invasion seems to be the most likely. Figure 1. (a) Ulcerative cancer of the left breast. (b) Plaques, nodules, and blisters localized in the left superior portion of the abdomen.

Zosteriform Cutaneous Metastases

“…The histotype of primary malignant tumor was various, with a relevant percentage of hematological malignancy and breast and skin carcinomas. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][44][45][46][47][48][49][50] Melanoma accounted for 19.6%, justifying the larger series of zosteriform metastases reported to date, with 11 of 56 cases described so far. [31][32][33][34][35][36][37][38] However, the prevalence of zosteriform metastases is lower than that of cutaneous melanoma localizations.…”

Review Literature of a Case of Multiple Distant Cutaneous Metastasis From Carcinoma Breast

“…Isolated scalp skin metastases is very little involvement. (12) In general, eight specific clinical patterns associated with cutaneous breast cancer are known: cancer en cuirasse, inflammatory metastatic carcinoma (carcinoma erysipelatodes), (1,13) carcinoma teleangiectaticum, (14) alopecia neoplastica, (15,16) Paget's disease, (17,18) breast carcinoma of the inframammary crease, (19) metastatic mammary carcinoma of the eyelid with histiocytoid histology, (20) nodular metastases, (21,22) and mucinous adenocarci-noma metastatic to the skin (1) . Skin metastases from breast carcinoma can also be present in a zosteriform distribution.…”

Metastatic adenocarcinoma of breast within a benign melanocytic nevus in the context of cutaneous breast metastatic disease

“…The others are carcinoma telangiectaticum, 13,18,19 alopecia neoplastica, 20,21 Paget's disease, 22‐26 breast carcinoma of the inframammary crease, 27 metastatic mammary carcinoma of the eyelid with histiocytoid histology, 28 nodular metastases 29‐31 and mucinous adenocarcinoma metastatic to skin 1,2,10 . Telangiectatic metastatic carcinoma has violaceous papulovesicles that may resemble lymphangioma circumscriptum, as tumor cells fill superficial lymphatic and blood vessels as a result of hematogenous spread.…”