We are reminded to be breast aware every October: to notice a new lump, a change in the shape of your breast, nipple changes or any unusual discharge.There is another important part of the breast that is sometimes overlooked, the skin.
The breast is covered by skin, and the same skin cancers that occur elsewhere on the body can develop on the breast as well. The most common skincancers are basal cell carcinoma, squamous cell carcinoma and melanoma which can all occur on the breast’s skin. In addition, certain forms of breast cancer can actually present with changes in the skin or nipple rather than with the breast lump we traditionally associate with breast cancer.
Being breast aware should therefore also mean being skin aware.
Basal cell carcinoma (BCC) is one of the most common forms of skin cancer. Although it occurs most frequently on chronically sun-exposed areas such as the face, neck and arms, it can develop on other areas of the skin too, including the breast and even, rarely, the nipple and areola.
A BCC may appear as a shiny or pearly bump, a pink or reddish patch, a small sore that repeatedly crusts or bleeds, or simply an area that refuses to heal.
A lesion does not need to be painful to be important.
Squamous cell carcinoma (SCC) can also occur on the skin of the breast.
It may present as a persistent rough or scaly patch, a crusted area, a firm enlarging lesion or a sore that does not heal. Any lesion that repeatedly bleeds, crusts, enlarges or changes deserves examination.
Melanoma can occur anywhere on the skin, and the breast is no exception.
Women may understandably focus on feeling for breast lumps and therefore overlook a changing mole or pigmented lesion on the breast itself.
Look for a mole or spot that is new or changing in size, shape or colour, looks different from your other moles, or starts itching, bleeding or developing other new symptoms. Important to remember, is that not every melanoma is dark brown or black. Some melanomas contain very little pigment and may appear pink or reddish and may have an even more aggressive character.
Eczema on the breast and nipple, isn’t always eczema. One particularly important condition to be aware of is Paget’s disease of the breast.
Paget’s disease is an uncommon form of breast cancer involving the skin of the nipple and often the areola. It can look remarkably similar to eczema.The nipple may become red, scaly or crusted. There may be itching or burning, discharge, bleeding or eventually a change in the shape of the nipple.
A particularly important warning sign is a persistent change affecting one nipple.
Paget’s disease is frequently associated with ductal carcinoma in situ (DCIS) or invasive breast cancer deeper within the breast.
This is why persistent unilateral “eczema” of the nipple should not simply be treated indefinitely with creams. If it does not resolve appropriately, further investigation, which may include a biopsy, is important.
Sometimes breast cancer itself can show on the skin. Breast cancer does not always announce itself with a lump.
Inflammatory breast cancer is a rare form of breast cancer that can cause rapid changes in the appearance of the breast because cancer cells obstruct lymphatic vessels in the skin.
The breast may become red or discoloured, swollen, warm or tender. The skin may become thickened or develop the characteristic dimpled appearance often described as peau d’orange, resembling the skin of an orange.
Importantly, there may not necessarily be a distinct lump.
Breast cancer can also involve the skin through local recurrence or spread. Persistent firm nodules, unexplained skin thickening, colour changes or a persistent rash, particularly in someone previously treated for breast cancer, should therefore be very thoroughly assessed.
What should you look for?
When checking your breasts, don’t only feel them. Look at them too.
Pay attention to the entire skin surface of the breasts, underneath the breasts, the nipples and the areolae.
Seek medical advice for a new or changing mole; a lesion that repeatedly bleeds, crusts or refuses to heal; a persistent scaly or rough patch; a new firm skin nodule; unexplained redness or swelling; peau d’orange; nipple inversion or discharge; or a persistent rash or eczema-like change affecting one nipple.
Most skin changes on the breast will not be cancer. Eczema, fungal infections, irritation, benign moles and many other harmless conditions are far more common.
But a persistent or changing lesion deserves attention.
Breast awareness is skin awareness.
Breast Cancer Awareness Month is an important reminder to know what is normal for your breasts.
- But don’t stop at checking for lumps.
- Look at the skin.
- Look underneath the breasts.
- Look at your moles.
- Look at your nipples.
Your skin can provide important clues to both skin cancer and breast cancer.
If something is new, changing or simply not healing as expected, have it examined.
Know your breasts. Know your skin. Don’t ignore a change.
