Skin metastases are secondary breast cancers that form on or just below the skin.
Secondary breast cancer happens when cancer cells spread from the breast to other parts of the body. Sometimes breast cancer cells can spread to the skin. This can happen through the blood or lymphatic system.
The most common sites affected are the areas near where the original breast cancer was – for example the skin of the chest wall or around the surgical scar. Less commonly, skin metastases can occur on other areas of skin, such as on the scalp, neck, abdomen, back and upper limbs.
About a fifth of people with secondary breast cancer will develop skin metastases.
This is not the same as having cancer that starts in the skin. The cells that have spread to the skin are breast cancer cells.
It’s also different to local recurrence, which is when primary breast cancer has come back in the chest or breast area, or in the skin near the original site or scar.
Symptoms of skin metastases include:
- a change in the colour of the skin
- a lasting rash
- a firm, painless nodule (small lump) or a number of nodules of different sizes
Sometimes the symptoms of skin metastases, such as redness and inflammation, may look like an infection of the skin called cellulitis.
Skin metastases can also cause lymphoedema, which is swelling of the arm, hand or breast area.
Other possible symptoms include:
- odour (smell)
A member of your treatment team will examine you and look at your skin. They’ll also discuss any other symptoms you have.
To confirm a diagnosis of secondary breast cancer in the skin, you may have a punch biopsy. You’ll be given a local anaesthetic before a tiny cutter device is used to take a very small piece of tissue from the area. It’s not unusual for the area to bleed a little after the biopsy so you’ll usually be given a small dressing or plaster afterwards.
You may also have a CT scan, also known as a CAT scan, to check for any other areas of spread. This type of scan uses x-rays to take a series of detailed pictures of the body. It’s painless but during the CT scan you have to lie still for around half an hour. Sometimes you will have dye injected into a vein, usually in your arm, before you have the scan so that different areas can be seen more clearly.
When breast cancer spreads to the skin, it can be treated but it cannot be cured. The purpose of treatment is to relieve symptoms, improve quality of life and slow the growth of the cancer.
Types of treatments
The treatment offered will depend on a number of factors. These include your symptoms, the type and features of the cancer, treatments you have had in the past and your general health.
Your treatment team will discuss treatment options with you, help you weigh up the potential benefits against possible side effects and explain what the aim of treatment will be for you.
Your treatment may include:
- specialist dressings
- electrochemotherapy (see below)
Find out more about treatment for secondary breast cancer.
What is electrochemotherapy?
Electrochemotherapy combines a low dose of a chemotherapy drug with electrical impulses. It’s given directly to the area being treated to relieve symptoms of skin metastases.
Studies have shown that electrochemotherapy can:
- help stop bleeding, broken skin (ulceration) and pain
- reduce the size of skin metastases
Using electrical impulses allows the chemotherapy to work in the treated areas only, with little or no effect in other areas. Electrochemotherapy won’t treat any other areas of secondary breast cancer inside the body.
How does it work?
Electrical impulses change the outer layer of the cancer cells in the treated area. Gaps called pores open up on the cells’ surface for a short time. This allows the chemotherapy drug to enter the cancer cells more easily. Once the pores close, the chemotherapy is sealed inside the cells.
The dose of chemotherapy drug is much lower than when it’s given to treat the whole body.
When is it given?
Electrochemotherapy may be used to treat skin metastases when other treatments haven’t worked or when surgery isn’t suitable.
It can also be given alongside other treatments, or given to skin which has previously been treated with radiotherapy.
Electrochemotherapy may not be suitable for some people with certain lung conditions.
How is electrochemotherapy given?
Many people need only a single treatment of electrochemotherapy, although it can be repeated in the same area or used to treat a different area.
Treatment is usually carried out as an outpatient or day case, though some people may need to stay in hospital overnight. This depends on how much treatment is needed and your general health.
It can be given under general anaesthetic or sometimes local anaesthetic, depending on the size of the area or how many areas need to be treated. You may be given pain relief beforehand.
The chemotherapy is usually given into a vein (intravenously). It can also be given by injection directly into the area of cancer being treated (intratumourally).
Bleomycin is the chemotherapy drug most commonly used. Cisplatin, another chemotherapy drug, may also be used.
A short time after the chemotherapy drug is given, electrical impulses are given directly to the area using an electrode with the help of a specially designed needle probe. The electrode may be applied a number of times to make sure the whole area is treated. The procedure usually takes about 30 minutes depending on the size of the area.
Afterwards, the area will often be covered with a dressing that may need changing regularly. The treated areas will usually scab over. Often the areas look worse before any improvement is seen.
Because the overall dose of chemotherapy is low, people don’t usually experience all the common side effects of chemotherapy, such as hair loss.
However, electrochemotherapy can cause side effects. Everyone reacts differently to treatments and some people have more side effects than others.
You may have pain in the area of skin that was treated, and it may feel warm.
Pain is often mild and is usually temporary, but may continue for a few weeks. Your doctor can prescribe pain relief to help.
Pain may be worse for people who already have pain caused by skin metastases, or when particular areas are treated, such as the breastbone (sternum).
Some people have muscle contractions when the electric impulses are given. This usually stops once treatment is finished, but can cause a cramp-like discomfort for a short time afterwards.
It’s common for the skin in the treated area to become lighter or darker in colour than before treatment. This skin change appears one to two weeks after treatment and may fade but is usually permanent.
Less common side effects
Less common side effects include:
- allergic reaction to the chemotherapy drug
- bleeding and oozing from the wound, especially if radiotherapy has been given to the area
- mild temperature, which usually goes down with paracetamol
- mild rash
- redness and swelling
- lung problems due to the side effect of the chemotherapy
Some people will have mild effects from the chemotherapy drug, such as nausea (feeling sick) and vomiting (being sick).
Electrochemotherapy is a relatively new treatment, but is now available in an increasing number of hospitals in England, Scotland and Wales.
You can ask your treatment team if this is a suitable treatment option for you. They can refer you to the nearest available location for treatment.
Everyone’s experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else who’s had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatever’s on your mind.
You can also call Breast Cancer Care’s Helpline free on 0808 800 6000.
Image credit: graphic adapted from: Sersa et al.Electrochemotherapy in treatment of tumours. European Journal of Surgical Oncology. 2008. 34: 232–240. Adapted by permission under the Creative Commons Attribution-ShareAlike 3.0 license:creativecommons.org/licenses/by-sa/3.0.