Chapter 5 – The Breast

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Inflammatory breast cancer

Inflammatory breast cancer is a specific clinical presentation of breast cancer that should be considered in the differential diagnoses of every inflammatory breast condition. It represents 1 – 2 per cent of breast cancers per year (24), and has a particularly poor prognosis.

The classic presentation is one of rapid onset of breast mass, pain, breast enlargement, and skin changes (red or purple, and ‘orange peel’ in appearance). Axillary lymph node involvement is almost universal.

Breast imaging may reveal subtle changes of increased skin thickness and increased tissue density rather than the classic features of breast cancer (such as a spiculated lesion with microcalcification).

All infective conditions should be followed to complete clinical and imaging resolution, and where an infective lesion does not resolve, or does not behave as expected, the diagnosis of inflammatory breast cancer should be considered. Inflammatory symptoms should be investigated as with other breast symptoms with imaging followed by fine needle biopsy or core biopsy of any abnormalities. Where there are significant skin changes such as erythema or an ‘orange peel’ appearance (peau d’orange), skin biopsy may confirm the diagnosis of inflammatory breast cancer.(12)

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