Orange Peel Appearance Research Articles

"Inflammatory Carcinoma" of the Breast

The gravity of inflammatory signs in the skin overlying a carcinoma of the breast has been appreciated for well over a century (3). Klotz (32) in 1869 and Volkmann (59) in 187S described “carcinomatous mastitis” as occurring particularly in young women during pregnancy and lactation. Bryant (9) first appreciated that the inflammatory signs were attributable to diffuse lymphatic blockage by cancer cells. Numerous other reports were published from time to time, the condition being variously described as acute brawny cancer, acute scirrhous carcinoma, acute medullary cancer, acute mammary carcinomatosis, lactation cancer, carcinoma mastitoides, inflamed cancer, etc. In 1924 Lee and Tannenbaum presented 28 cases of the disease under the title “Inflammatory Carcinoma of the Breast” (37). Many smaller groups of cases have since been reported, adding to the already formidable list of names applied to the condition. Despite this multiplicity of terms, however, one significant advance is to be noted: whereas in 1924 it was difficult to convince the medical profession that the inflammatory signs were of a cancerous nature (37), today that fact is universally accepted.Definition: As we shall show in our study, the “inflammatory” type of carcinoma of the breast presents certain clinical characteristics and certain pathological peculiarities. Since pathological material is not available in all cases, and since special pathological study is often necessary to demonstrate the typical invasion of lymphatic vessels, most of the cases included in this study were selected on the basis of clinical characteristics alone. These characteristics, justifying the designation “inflammatory,” are redness, heat, edema, orange-peel appearance of the skin, diffuse and ill-defined swelling, and sometimes pain and tenderness. All of these features are not present in every case, and those which are present may vary in degree. No one of them alone is sufficient to justify the clinical diagnosis. Thus in the absence of pathological proof, there may be disagreement among clinical observers as to whether a given case is or is not “inflammatory carcinoma”; and the possibility of such disagreement is increased when decision must be made on the basis of a study of records and photographs rather than of the patients themselves. We have carefully reviewed our cases of carcinoma of the breast and believe that those included in this report presented characteristics justifying the designation, inflammatory carcinoma.