Case ReportReflectance confocal microscopy in early diagnosis of cutaneous metastases of breast cancer
Introduction
Cutaneous metastases in patients with metastatic breast cancer can occur in up to 30% after a mean time of 3.1 years, mostly in those with ductal carcinomas. Clinical presentation varies from skin-colored to red macules, papules and plaques sometimes with necrosis. Even inflammation mimicking erysipelas can be observed [1].
In vivo reflectance confocal microscopy (RCM), a near-infrared 839 nm laser scanning microscope, is a promising new technology with the unique possibility to evaluate skin structures at cellular level in vivo. A single view of field has approximately 500 × 500 μm and a resolution of 1024 × 1024 pixels. Moving the focus plane in and out of the lesion, a stack of images can be generated. Penetration depth of imaging is about 200–500 μm and allows an overview over of the epidermis and the superficial dermis showing grayscale pictures. The procedure lasts about 15 min, is painless and causes no tissue damage. It has been shown that RCM can be used in early diagnosis of skin cancers [2], [3], [4]. RCM also appears useful in the early diagnosis of breast cancer metastatic to the skin, as a recent case of ours shows.
Section snippets
Case report
A 57-year-old woman was referred by the Department of Internal Medicine with three erythematous papules of rapid onset on the left infraclavicular region. The patient interpreted the papules as likely insect bites, but treatment with topical antihistamines produced no improvement for 3 weeks. There was a history of breast cancer surgery for an invasive ductal mammary carcinoma of the left breast with lymph node metastases (pT2 N1biii (2/17) M0 G2 with positive estrogen and progesterone
Discussion
This case illustrates the utility of RCM in early diagnosis of cutaneous metastases of breast cancer. Although final diagnosis was made by histopathologic confirmation, RCM helped to exclude the differential diagnoses and lead to the correct diagnosis, as well as helping convince the patient to accept a most necessary biopsy. In dermatology diagnostic possibilities have been enlarged by this technique avoiding unnecessary biopsies by providing a sort of “virtual biopsy.” In melanocytic skin
Conflict of interest statement
The authors have no conflict of interest to disclose.
References (4)
- et al.
Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients
J. Am. Acad. Dermatol.
(1993) - et al.
In vivo confocal laser scanning microscopy in the diagnosis of melanocytic skin tumours
Brit. J. Dermatol.
(2009)
Cited by (2)
Dermoscopy and novel non invasive imaging of Cutaneous Metastases
2022, Advances in Cancer Biology - MetastasisCutaneous metastasectomy: Is there a role in breast cancer? A systematic review and overview of current treatment modalities
2022, Journal of Surgical Oncology