Microsoft Word - IJHHS IMAM 23rd ASC 2022


  
 

 S22

Metastatic Breast Carcinoma with Cutaneous Metastasis and Right Pleural Effusion   

 
 Adib Zakhi1   
  

Cutaneous metastasis is when cancerous cells spread from a primary tumour to the skin. This 
is a case of a 75-year-old patient who developed skin metastasis with underlying primary breast.  

A 75-year-old lady presented with a 3-week history of the progressive appearance of multiple 
asymptomatic nodular lesions on the chest. Eight months earlier, she was diagnosed with right breast 
carcinoma and underwent neoadjuvant chemotherapy followed by a right modified radical mastectomy. 
She presented with progressive skin lesion over the right upper limb and anterior chest wall. She denied 
any fever, pain or pruritus and any preceding burn or trauma. She also completed a course of antibiotic 
for the lesion. Physical examinations revealed an erythematous lesion with multiple exophytic nodules. 
It was painless and extended from the anterior chest wall to the right upper limb. Lung auscultation 
revealed reduced air entry over the right upper zone. She was then referred to the Oncology Department 
and diagnosed with metastatic breast carcinoma with right pleural effusion and cutaneous metastases. 
As she was unfit for further systemic therapy, she was discharged home and continuation of supportive 
care. Chest radiograph revealed right upper lobe opacity and bedside ultrasound confirmed right upper 
lobe pleural effusion. Other investigations were unremarkable.  

Cutaneous metastasis accounts for 24% of breast carcinoma and may manifest as the presenting 
lesion or after the tumour diagnosis. The commonest manifestation is the presence of nodules in the 
ipsilateral chest wall to the primary tumour, their size varies, is painless and are commonly spread via 
lymphatic drainage. Skin biopsy helps in diagnosis confirmation. Definitive treatment depends on the 
management of the primary malignancy. As it may mimic benign lesions, one should be highly 
suspicious of skin metastasis as he might be the first person to identify the primary tumour.  
  
Keywords: Emergency Department, Cutaneous Metastasis, Pleural Effusion   
  

1. Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia    
  

 

 

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Correspondence to:  Adib Zakhi, Medical Officer, Hospital Canselor Tuanku Muhriz Malaysia, 
adibzakhi@rocketmail.com 

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DOI: http://dx.doi.org/10.31344/ijhhs.v7i70.524