PEAU D’ORANGE: Late Sign of Breast Cancer

In advanced stage of breast cancer, a woman may see or feel that the skins of her breast/ breasts have turned liked the skin of the orange. This Peua D’orange or orange-peel skin is the late sign if a progressing breast cancer which is edematous thickening and pitting of breast skin. It naturally occurs in case of Inflammatory Breast Cancer which is usually an aggressive type of breast cancer and can occur in woman of any age group. It is dangerous as because there is absence of any lump or internal palpable structures and this is not detectable in Ultrasonography or Mammography. Some other factors also cause same condition like breast or axillary lymph node infection, erysipelas or Graves’ disease.

The subject may face following conditions:

• Pain or tenderness.
• Rapid increase in breast size.
• Malaise.
• Presence of a fixed or mobile lump or nodule in any part of the breast.
• Severe weight-loss.
• Any discharge from the breasts.
• Nipples may be deviated, retracted and dimpling or cracking may be present.
• Enlargement of the Lymph nodes.
• The site will be felt warm.
• Redness or abnormal color of the skin.

Some specific groups of women are prone to suffer. Such as:

• Who ignores or neglects breast feeding to their babies
• Who doesn’t maintain personal hygiene.
• Women who are in sever mental and physical stress or depression.
• Women who so not follow family planning methods.
• Self induced hormone therapy.

This clinical condition may be caused due to:

• In case of Breast Abscess:
  This infectious disorder usually occurs in lactating woman due to milk stasis. Here Peau D’orange is associated with fever, malaise, breast tenderness and erythema. Onset of fever may be sudden and accompanied by shaking chills. Purulent discharge may be present in a cracked nipple. A palpable soft mass may be present.
• In case of Breast Cancer:
  It occurs to the most dependent part of the breast in case breast cancer where there is Lyphedema. On inspection of the breast changes in contour, size or symmetry is seen. On palpation, a firm, immobile mass of tissue is felt which adheres under the skin just above the site where Peau D’orange is seen. Moreover deviation, retraction, erosion and dimpling or cracking may be present with thin, watery, bloody or purulent discharge There is burning pain or itching. But breast pain may occur due to so many causes so pain is not a reliable indicator of Cancer.

The cause of it can not be diagnosed by doing ultrasonography or mammography. Sometimes it may be misdiagnosed as mastitis, insect bite or allergic reaction. So, it is diagnosed histologically by the presence of cancer cells in lymph nodes or skin biopsy. The diagnosis is done by Biopsy of Lymph node or by doing MRI.

This clinical condition usually signals advanced stage of breast cancer, so it is really important to provide emotional support to the patient as soon as it is diagnosed. The diagnostic and therapeutic process should be explained to her to decrease her fear and to make her more cooperative during those processes.

Post-menopausal woman should self-check their breasts on a regular basis to detect any abnormality in the breast at an early stage so that the treatment and prognosis can be successful.