Eur J Plast Surg (2006) 29: 44–46
A perplexing presentation of a breast carcinoma: a case report
Received: 25 July 2005 / Accepted: 19 October 2005 / Published online: 17 December 2005
# Springer-Verlag 2005
Abstract Breast cancer is a devastating disease for
women. In this paper, we present a breast carcinoma
presenting in a bizarre location. It was initially presumed
that the patient had skin cancer, but the lesion turned out to
be breast cancer presenting as a superficial mass on the skin
of the breast.
Keywords Breast cancer
The risk for a woman developing breast cancer increases
with increasing age . Breast malignancies are broadly
divided into epithelial tumors of the cells lining ducts and
lobules, and nonepithelial malignancies of the supporting
stroma. A second important division of epithelial tumors is
between noninvasive and invasive cancers.
In this paper, a breast carcinoma occurring in a bizarre
location is presented.
A 36-year-old woman was referred to the Plastic Surgery
Clinic with a fungating mass on the chest adjacent to the
upper pole of the left breast. Upon physical examination,
she was found to have a red fleshy mass measuring
5.0×3.5 cm on the chest skin adjacent to the upper outer
quadrant of the left breast (Fig. 1). The first impression was
of a skin cancer with a possible extension to the chest wall.
It did not seem to be a breast cancer. An initial aspiration
biopsy suggested malignancy; she then underwent an
incisional biopsy, which turned out to be infiltrative ductal
carcinoma of the breast (Fig. 2). Computerized tomography
showed a mass with possible extension to the breast tissue
(Fig. 3). Further work-up showed enlarged lymph nodes in
the left axilla and multiple metastatic masses in the lungs.
After discussion with the medical oncologists and general
surgeons, she was treated with chemotherapy.
Breast cancer usually presents in a predictable nature either
as a palpable or nonpalpable mass in the breast or with
calcifications on mammography. These malignant lesions
are frequently diagnosed correctly on physical examina-
tion, even by those with moderate experience . Metas-
tasis to the breast from other areas can occur but this is very
unusual [2, 3].
The optimum treatment for locally advanced and inflam-
matory carcinoma remains controversial. Systemic therapy,
radiation therapy, and surgery are often combined with the
goal of reducing local and distant treatment failure .
In the case presented, the initial diagnosis was a skin
tumor; the diagnosis of breast cancer was a considerable
surprise. Unfortunately, it was not amenable to surgical
treatment. The major misleading factor was the location of
tumor on the skin vaguely involving the breast tissue.
Although this case is uncommon in the realm of plastic
surgery, it was thought to be a skin problem because of its
superficial position. This is simply another pathology that
has to be considered when a tumor in this area presents. It
would have been relatively easy to make the wrong diag-
nosis and consequently provide the wrong treatment.
B. Civelek (*)
Department of Plastic and Reconstructive Surgery,
S.B. Diskapi Hospital,
Kehribar Sokak 9/24,
G.O.P., 06700, Ankara, Turkey