Clinical Cases in Geriatric Dermatology by Robert A. Norman & Justin Endo

Author:Robert A. Norman & Justin Endo
Language: eng
Format: epub
Publisher: Springer London, London

Based on the case description and the photograph, what is your diagnosis? 1.Contact dermatitis

2.Pressure necrosis

3.Resistant tinea corporis

4.Impetigo

5.Breast metastasis

Diagnosis

Breast metastasis

Discussion

Breast carcinoma can spread to overlying skin through regional lymphatics (De Giorgi et al. 2010; Fisher et al. 1975; Hussein 2010) but can also metastasize to distant sites such as the scalp. Contrary to other cutaneous metastatic diseases, breast cancer metastases are not always palpable papules or nodules but can manifest as inflammatory red patches or minimally scaly or crusted plaques on the chest wall (Krathen et al. 2003; Nashan et al. 2010; Schwartz 2008).

Our patient was referred back to her oncologist for consideration of further surgery and chemotherapy.

Contact dermatitis from topical medication or some other allergen can cause a red, itchy, crusted, nonsubstantive plaque. One would expect more surface change (weeping, oozing, crusting, and blistering) with this condition.

Pressure necrosis of the skin overlying the tissue expander could cause crusting, but the lack of a necrotic eschar fails to support this diagnosis.

Tinea corporis can cause a unilateral, scaly, erythematous plaque, similar to what is seen in this case. However, the scale is typically at the advancing margin of the lesion rather than in the center. Potassium hydroxide preparation of skin scraping can be a fast, inexpensive test. Given the patient’s history, lack of response to topical antifungals, cutaneous metastasis should be ruled out with skin biopsy.

Impetigo commonly causes a yellow-crusted, localized, inflamed plaque. The relatively small amount of surface change as compared with the amount of erythema makes this less likely.

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