View source for Paget's disease of the breast differential diagnosis

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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Paget%27s_disease_of_the_breast]]
{{CMG}};{{AE}} {{Preeti}}
==Overview==
Paget's disease of the breast must be differentiated from [[atopic dermatitis]], [[eczema]], [[psoriasis]], [[Melanoma|malignant melanoma]], [[Bowen's disease]], [[basal cell carcinoma]], and pagetoid dyskeratosis.<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref><ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref>

==Differential Diagnosis==
Paget’s disease of the breast must be differentiated from other benign and malignant processes of nipple-areola complex such as:

*[[Atopic dermatitis]]
*Chronic contact dermatitis
*[[Duct ectasia of breast|Lactiferous duct ectasia]]
*[[Eczema|Chronic eczema]]
*[[Psoriasis]]
*Nipple duct adenoma
*[[Melanoma|Malignant melanoma]]
*[[Bowen’s disease]]
*[[Basal cell carcinoma|Superficial basal cell carcinoma]]
*[[Intraductal papilloma|Benign intraductal papilloma]]
*Pagetoid dyskeratosis

Paget's disease of the breast is often misdiagnosed as nipple eczema  

{|
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign or Malignant
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! rowspan="2" |Para-clinical findings
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold Standard
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Associated factors'''
|-
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Rash
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nipple Discharge
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Erythema
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mastalgia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Breast Exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
! rowspan="20" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin disorders
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Paget's disease of the breast<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref><ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref>
| align="center" style="background:#F5F5F5;" |[[Malignant]]
| align="center" style="background:#F5F5F5;" |Most the patients have underlying [[Breast cancer|breast cancer.]]
| align="center" style="background:#F5F5F5;" |Ulcerated, crusted, or scaling lesion on the [[nipple]] that extends to the [[areolar region]] 
| align="center" style="background:#F5F5F5;" |Serous or bloody [[nipple discharge]] may be present.
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |
* Well-demarcated [[erythematous]] and [[Desquamation|desquamative plaques]] with irregular borders seen.
* [[Breast lump]] palpated in >50% cases.
| align="center" style="background:#F5F5F5;" |Usually unilateral nipple is effected
| align="center" style="background:#F5F5F5;" |
* The Paget cells are large round [[cells]] with abundant clear [[cytoplasm]] and [[atypical nuclei]]. 
* The cytoplasm is often [[Periodic acid-Schiff|periodic-acid-Schiff (PAS)]] positive
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* [[Biopsy]]
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* 90% of the cases  will have an invasive [[Ductal carcinoma|intraductal carcinoma of the breast]].
* May positive staining against [[CEA antigen]]  and the c erbB-2 / her-2 neu oncoprotein.
* Prognosis is worse in men.
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Extramammary Paget's disease]]
| align="center" style="background:#F5F5F5;" |[[Malignant]]
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| align="center" style="background:#F5F5F5;" |[[Biopsy]]
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|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Atopic dermatitis]]
([[Eczema]])
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* [[Benign]]
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* Epidermal barrier dysfunction
* [[Immune]] dysregulation
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*[[Erythema]], [[Exudate|exudates]], [[papules]],[[vesicles]], scales and crusts
* Infiltrated [[erythema]], [[prurigo]], scales and crusts
| align="center" style="background:#F5F5F5;" | –
| align="center" style="background:#F5F5F5;" | –
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| align="center" style="background:#F5F5F5;" | –
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* Usually bilateral nipple is effected with no accompanying induration.
* Centrofacial pallor
* Delayed blanch response
* [[Keratosis pilaris]]
* Palmar hyperlinearity
* [[Pityriasis alba]]
* [[Ichthyosis]]
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* Epidermal psoriasiform [[hyperplasia]]
* Marked intercellular [[edema]] with spongiotic vesiculation
* [[Hyperkeratosis]]
* Psoriasiform [[hyperplasia]]
* [[Dyskeratosis congenita|Dyskeratosis]]
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* 
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* [[Family history]] of  [[atopy]]
* History of [[Breast implants|silicon implants]] or [[Breast reconstruction|reconstruction]] of nipple areola complex or [[lactation]].
* Personal history of [[atopy]] or [[extramammary Paget's disease]] or [[hematological diseases]]
* Combined usage of [[interferon alfa-2b]] and [[ribavirin]].
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Papillary adenoma of the nipple|Erosive adenomatosis of the nipple]]<ref name="pmid23984247">{{cite journal |vauthors=Kumar PK, Thomas J |title=Erosive adenomatosis of the nipple masquerading as Paget's disease |journal=Indian Dermatol Online J |volume=4 |issue=3 |pages=239–40 |date=July 2013 |pmid=23984247 |pmc=3752489 |doi=10.4103/2229-5178.115534 |url=}}</ref><ref name="pmid962337">{{cite journal |vauthors=Lewis HM, Ovitz ML, Golitz LE |title=Erosive adenomatosis of the nipple |journal=Arch Dermatol |volume=112 |issue=10 |pages=1427–8 |date=October 1976 |pmid=962337 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* [[Benign]]
* Neoplasm of breast lactiferous ducts
| align="center" style="background:#F5F5F5;" |
* [[Proliferation]] of the inner  [[Epithelial|epithelial layer]] and outer, [[basal layer]] of [[myoepithelial cells]] of the [[Lactiferous duct|lactiferous ducts]]  the [[nipple]].
| align="center" style="background:#F5F5F5;" |[[Eczema]], crusts or erosion of nipple
| align="center" style="background:#F5F5F5;" |Serous or bloody [[nipple discharge]].
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
* [[Nipple]] may have unencapsulated, firm  [[Granuloma|granulomatous lesion]] .
* A non-tender [[nodule]] either within or under the [[nipple]] adherent to the [[skin]], but not the [[breast]] may be palpated. 
| align="center" style="background:#F5F5F5;" |
* Insidious onset.
* [[Erythema]] may be seen prior to [[erosion]].
* No  [[lymphadenopathy]].
| align="center" style="background:#F5F5F5;" |
* Overlying epidermis often shows [[acanthosis]] and [[hyperkeratosis]]. 
* Papillomatous pattern: [[vascular]] papillae project into dilated [[lumina]] and are surrounded by [[Epithelial cells|proliferating epithelial cells]] .

* [[Papilla|Papillary]] pattern:  [[cells]] proliferate into large cords with deep fissures and clefts and dense [[stroma]].
| align="center" style="background:#F5F5F5;" |[[Biopsy]]: Shows absence of [[Atypia|cytological atypia]]
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* [[Incidence]] is highest in the fifth decade in women.
* No  [[lymphadenopathy]].
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Contact dermatitis|Allergic contact dermatitis]]<ref name="pmid19447733">{{cite journal |vauthors=Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF |title=Allergic and irritant contact dermatitis |journal=Eur J Dermatol |volume=19 |issue=4 |pages=325–32 |date=2009 |pmid=19447733 |doi=10.1684/ejd.2009.0686 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |[[Benign]]
| align="center" style="background:#F5F5F5;" |
* Delayed-type [[hypersensitivity]] response
* Skin [[inflammation]] mediated by [[Haptens|hapten]]-specific T cells
| align="center" style="background:#F5F5F5;" | Erythematous well-demarcated [[papules]]
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
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* Stinging and burning
* Localized [[swelling]]
* [[Lichenification|Lichenified]] [[Itch|pruritic]] [[plaques]]
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* [[Eosinophilic]] spongiosis and [[microvesicles]]
* [[Exocytosis]] of [[eosinophils]] and [[lymphocytes]] 
* Chronic - [[Hyperkeratosis]] and [[parakeratosis]]
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*
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* Contact with [[allergens]] in the past 1-2 days
* Positive [[family history]]
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Psoriasis]]
| align="center" style="background:#F5F5F5;" |[[Benign]]
| align="center" style="background:#F5F5F5;" |
* [[Keratinocyte]] hyperproliferation
* Dysregulation of the [[immune system]]
| align="center" style="background:#F5F5F5;" | Well-circumscribed, pink [[papules]] and symmetrically distributed cutaneous [[plaques]] with silvery scales
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +

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| align="center" style="background:#F5F5F5;" |[[Auspitz's sign]]  (pinpoint bleeding)
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* [[Epidermal]] [[hyperplasia]]
* Parakeratosis
* [[Neutrophils]] microabscesses (Munro microabscesses)
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* [[Epidermal]] [[hyperplasia]]
* Parakeratosis
* [[Neutrophils]] microabscesses (Munro microabscesses)
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Risk factors include
* [[Smoking]]
* Skin trauma
* [[Alcohol abuse]]
* [[Stress]]
* Cold weather
* Vitamin D deficiency 
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Melanoma|Malignant melanoma]]
| align="center" style="background:#F5F5F5;" |[[Malignant]]
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* [[Neural crest cell]] derivative
* Development begins with disruption of [[nevus]] growth control
* Progression involves [[MAPK/ERK pathway]]
* [[RAS|N-RAS]] or [[BRAF]] [[oncogene]]<nowiki/>also involved
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* Macule
* Plaque with irregular border
* Variable size

* A lesion with [[ABCD]]
** Asymmetry
** Border irregularity
** Color variation
** Diameterchanges
* [[Bleeding]] from the lesion
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
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* [[Ultraviolet|UV radiations]]
* [[Genetic predisposition]]
* [[Old age]]
* Male gender
* Family or personal history of [[melanoma]]
* Multiple benign or atypical [[Nevus|nevi]]
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]
| align="center" style="background:#F5F5F5;" |[[Benign]] can turn [[malignant]]
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* Erythematous
* Skin colored

* Patch
* Plaque
* scaly
* variable size
| align="center" style="background:#F5F5F5;" |–
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* Presence of dotted and/or glomerular vessels
* White to yellowish surface scales
* Red-yellowish background
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* Keratinocytic dysplasia of the epidermis
* No infiltration into dermis

* Pleomorphic keratinocytes
* Hyperchromatic nuclei
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* Slow growth over the years
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Basal cell carcinoma|Superficial basal cell carcinoma]]
| align="center" style="background:#F5F5F5;" |[[Malignant]]
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* Erythematous
* Superficial scaly patch
| align="center" style="background:#F5F5F5;" |–
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* Superficial fine telangiectasia
* Shiny white to red, translucent or opaque structureless areas
* Multiple small erosions
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* Large, hyperchromatic, oval nuclei
* Minimal cytoplasm
* Small basaloid nodules
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* Higher incidence in men
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intraductal papilloma|Benign intraductal papilloma]]
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |Pagetoid dyskeratosis
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Duct ectasia of breast|Lactiferous duct ectasia]]
| align="center" style="background:#F5F5F5;" |[[Benign]]
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* Common among [[perimenopausal]] <nowiki/>women

* Usually resolve spontaneously
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| align="center" style="background:#F5F5F5;" |[[Ultrasound]]:
* Dilated milk ducts
* Fluid-filled ducts
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|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nevoid hyperkeratosis|Nevoid hyperkeratosis of the nipple and areola]]  (NHNA) <ref name="pmid28004028">{{cite journal |vauthors=Mazzella C, Costa C, Fabbrocini G, Marangi GF, Russo D, Merolla F, Scalvenzi M |title=Nevoid hyperkeratosis of the nipple mimicking a pigmented basal cell carcinoma |journal=JAAD Case Rep |volume=2 |issue=6 |pages=500–501 |date=November 2016 |pmid=28004028 |pmc=5161776 |doi=10.1016/j.jdcr.2016.09.007 |url=}}</ref><ref name="pmid24082214">{{cite journal |vauthors=Ghanadan A, Balighi K, Khezri S, Kamyabhesari K |title=Nevoid Hyperkeratosis of the Nipple and/or Areola: Treatment with Topical Steroid |journal=Indian J Dermatol |volume=58 |issue=5 |pages=408 |date=September 2013 |pmid=24082214 |pmc=3778809 |doi=10.4103/0019-5154.117347 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |[[Benign]]
| align="center" style="background:#F5F5F5;" |
* Common among [[premenopausal]] women

| align="center" style="background:#F5F5F5;" |Slow growing bluish-brown  verrucous thickening of the nipple or areola.
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
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* The skin of the [[nipple]] and [[areola]] is thickened and [[hyperpigmented]] developing an isolated [[Nevus|nevoid]] defect .
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* Usually bilateral nipple is effected
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* [[Acanthosis]], [[hyperkeratosis]], and [[papillomatosis]] of [[Epidermis|the epidermis]]
| align="center" style="background:#F5F5F5;" |[[Biopsy]]
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* NHNA might be hormonal [[hyperkeratosis]] as it is shown to worsen in [[pregnancy]].
* Might seperately effect the [[nipple]] or only the [[areola]]
* Associated with [[Darier’s disease]], chronic [[acanthosis nigricans]], [[Cutaneous T cell lymphoma|cutaneous Tcell lymphoma]], [[Mycosis fungoides cost-effectiveness of therapy|mycosis fungoides]], and [[follicular mucinosis]].
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |Benign Toker cell  hyperplasia
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Breast abscess]]
| align="center" style="background:#F5F5F5;" |[[Benign]]
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* Complication of lactational [[mastitis]] in 14% of cases
* Common among African-American women, heavy smokers and [[obese]] patients.
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* [[Inflammation]] of [[nipple]] [[Areolar tissue|areolar]] complex
* Dimpling of [[nipple]] or inversion.
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
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* Localized breast [[edema]] leading to [[breast]] [[tenderness]]
* Swollen warm [[breast]] [[tissue]].
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* Associated symptoms of fever, nausea, vomiting.
* Resolve after drainage/[[antibiotic therapy]].
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* Mixed [[inflammatory]]<nowiki/>feature by [[neutrophils]].
* [[Granulation tissue]]<nowiki/>and [[chronic]][[inflammation]] feature caused by [[Gram-positive cocci]].
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[[Ultrasound]]:
* Fluid collection
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* [[Smoking]] history
* If not lactating, patient may be [[Diabetes mellitus|diabetic]]. 
* History of privious breast infection
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mondor's disease|Mondors disease]]<ref name="pmid20890261">{{cite journal |vauthors=Hokama A, Fujita J |title=Mondor disease: an unusual cause of chest pain |journal=South. Med. J. |volume=103 |issue=11 |pages=1189 |date=November 2010 |pmid=20890261 |doi=10.1097/SMJ.0b013e3181ecfcf3 |url=}}</ref><ref name="pmid11566698">{{cite journal |vauthors=Shetty MK, Watson AB |title=Mondor's disease of the breast: sonographic and mammographic findings |journal=AJR Am J Roentgenol |volume=177 |issue=4 |pages=893–6 |date=October 2001 |pmid=11566698 |doi=10.2214/ajr.177.4.1770893 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |[[Benign]]
| align="center" style="background:#F5F5F5;" |Superficial [[phlebitis]] and [[periphlebitis]] of the superficial vein.
| align="center" style="background:#F5F5F5;" |Red linear cord running from the lateral margin of the [[breast]] attached to the overlying skin.
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
* Red tender cord which may last up to 4-8 weeks before spontaneously [[remitting]] leaving a puckered groove along the [[breast]].
| align="center" style="background:#F5F5F5;" |
* Usually unilateral [[nipple]] is effected
* No associated [[lymphadenopathy]].
| align="center" style="background:#F5F5F5;" |
* N/A–
| align="center" style="background:#F5F5F5;" |
* [[Mammography]]: shows [[tubular]] density.
* [[Ultrasound]]: [[Tubular]] anechoic structure and multiple narrowing areas.
| align="center" style="background:#F5F5F5;" |
* Predominantly seen in middle-aged women but is also seen in men.
* May indicate breast cancer. 
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mastitis]]<ref name="pmid18394188">{{cite journal |vauthors=Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C |title=The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment |journal=Int Breastfeed J |volume=3 |issue= |pages=6 |date=April 2008 |pmid=18394188 |pmc=2322959 |doi=10.1186/1746-4358-3-6 |url=}}</ref><ref name="pmid11790672">{{cite journal |vauthors=Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K |title=Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States |journal=Am. J. Epidemiol. |volume=155 |issue=2 |pages=103–14 |date=January 2002 |pmid=11790672 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* [[Benign]]
* No increased risk of [[malignancy]]
| align="center" style="background:#F5F5F5;" |
* Common among [[lactating]] women (first three months of [[breast-feeding]])
* Periductal [[mastitis]] among [[smokers]] associated with [[squamous]] [[metaplasia]].
| align="center" style="background:#F5F5F5;" |
* Localized [[erythema]], warmth, swelling, and pain.
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" |
* Swollen warm [[breast]]  [[tissue]].
| align="center" style="background:#F5F5F5;" |
* Associated symptoms of  fever, chills, or rigor may be present.
* Resolve after drainage/[[antibiotic therapy]]
| align="center" style="background:#F5F5F5;" |
[[Breast]] [[parenchyma]][[inflammation]]:
* [[Acute]] [[mastitis]]: [[Staphylococcus]] [[infection]]
* [[Granulomatous]] [[mastitis]]: [[Tuberculosis]] or [[sarcoidosis]][[infection]]
| align="center" style="background:#F5F5F5;" |
[[Ultrasound]]:
* Ill-defined area with hyperechogenicity with inflamed fat lobules
* Skin thickening.
| align="center" style="background:#F5F5F5;" |History of [[lactation]] including difficulty in [[breastfeeding]], [[breast engorgement]], or [[erosion]] of  [[nipples]].
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inflammatory Breast Cancer]]<ref name="pmid25034439">{{cite journal |vauthors=Matro JM, Li T, Cristofanilli M, Hughes ME, Ottesen RA, Weeks JC, Wong YN |title=Inflammatory breast cancer management in the national comprehensive cancer network: the disease, recurrence pattern, and outcome |journal=Clin. Breast Cancer |volume=15 |issue=1 |pages=1–7 |date=February 2015 |pmid=25034439 |pmc=4422394 |doi=10.1016/j.clbc.2014.05.005 |url=}}</ref><ref name="pmid20603440">{{cite journal |vauthors=Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA, Dirix LY, Levine PH, Lucci A, Krishnamurthy S, Robertson FM, Woodward WA, Yang WT, Ueno NT, Cristofanilli M |title=International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment |journal=Ann. Oncol. |volume=22 |issue=3 |pages=515–23 |date=March 2011 |pmid=20603440 |pmc=3105293 |doi=10.1093/annonc/mdq345 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |[[Malignant]]
| align="center" style="background:#F5F5F5;" |Cancer cells block the lymphatic vessels in skin covering the breast
| align="center" style="background:#F5F5F5;" |
* Localized [[erythema]], warmth, swelling, and pain.
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
* Usually unilateral

* Swollen warm tender [[erythematous]]  [[breast]] [[tissue]].
* Peau d’orange: Dimpling on the [[skin]] of the affected [[breast]].
| align="center" style="background:#F5F5F5;" |
* Generally associated with [[Lymphadenopathy|lymphadenopathy.]]
| align="center" style="background:#F5F5F5;" |
* [[Dermal]] [[lymphatic]] invasion by [[Tumor cell|tumor cells]].
| align="center" style="background:#F5F5F5;" |Core needle [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
* Rare [[Disease|disease,]] accounts for 0.5–2 % of invasive [[breast cancers]] .
* Considered locally [[Cancer|advanced cancer]].
* Rapid change in the appearance of the effected [[breast]]
* Higher cases of [[visceral]] [[metastases]] due to early and aggressive [[hematogenous]] spread.
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|}

==References==
{{reflist|2}}

[[Category:Disease]]
[[Category:Breast cancer]]
[[Category:Epidermal nevi, neoplasms, cysts]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Breast]]
[[Category:Mature chapter]]
[[Category:Needs content]]
 [[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gynecology]]
[[Category:Surgery]]