According to TNM staging involvement of dermis is not a sign of T4, and we need epidermis involvement to assign a tumor as T4b.
Is this means that we need histologic evaluation of Peau d'orange skin before considering it as T4 tumor?
Remember that Peau d'orange skin in breast CA can occur with dermis involvement and dose not means epidermis involvement in all cases.
I have a case with breast CA approved with FNA and she has Peau d'orange skin. I want to know should I send him for neoadjuvant chemotherapy or should take a skin biopsy first?Thank you in advance for your help.
This term means "orange skin" in French. It's when the skin of the breast looks like the skin of a navel orange: It gets swollen and the hair follicles look like lots of little dimples. This can be a sign of inflammatory breast cancer( IBC).
Inflammatory breast cancer (IBC) is a rare and very aggressive form of breast cancer. According to the National Cancer Institute, about 1-5% of all breast cancer cases in the United States are inflammatory breast cancers.
IBC usually starts with the reddening and swelling of the breast instead of a distinct lump which mean it difficult to be detected by mammogram. IBC tends to grow and spread quickly, with symptoms worsening within days or even hours.it is usually found at a locally advanced stage, meaning that cancer cells have spread into nearby breast tissue or lymph nodes which can considered as stage T4.
If I have correctly understand your question... AJCC T4b definition is: Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d'orange) of the skin, which do not meet the criteria for inflammatory carcinoma.
Peau d'orange is not a reliable indicator of T4 disease. This type of skin change can be seen in the absence of tumor cells from the edema secondary to lymph node dissection and from other causes such as cellulitis. Biopsy should always be performed to confirm the presence of tumor cells. Punch biopsy is superior to core needle or FNA since it preserves the surrounding architecture.
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