Cancer of the breast
Although dimpling of the skin is present in the vast majority of patients with cancer of the breast, it must be appreciated that there are a number of other conditions, such as fat necrosis, healed acute inflammation, cysts, sclerosing adenosis, occasionally a healed incision, etc., that may pro duce dimpling.
Abstract
DR. COLE: Early diagnosis is so im portant in cancer of the breast, as it is in other cancers, that we consider a brief discussion of physical signs ap propriate. A mass is usually palpable although it must be realized that in 1 to 2 per cent of cases axillary metas tases may be present before a mass be comes palpable in the breast itself. Characteristically the mass is non tender, firm, slightly nodular and has an ill-defined periphery. Orange-peel skin, which is produced by edema, is either a fairly late sign or an indica tion of an invasive tumor. Dimpling of the skin (Fig. 1) is not as pathogno monic of cancer as is axillary metas tasis, but since palpable metastatic nodes are present in no more than half of the patients when first seen, dim pling becomes a much more valuable sign; it will be present in about 85 per cent of cases, but in 8 to 10 per cent of cases the sign can be demonstrated only by skillful shifting of the mass from side to side by an experienced diagnostician. Although dimpling of the skin is present in the vast majority of patients with cancer of the breast, it must be appreciated that there are a number of other conditions, such as fat necrosis, healed acute inflammation, cysts, sclerosing adenosis, occasionally a healed incision, etc., that may pro duce dimpling. Of these lesions, fat necrosis is the most important because it is often indistinguishable from can cer except by biopsy; fortunately it is rather uncommon. Dr. Slaughter, would you care to add to this discussion of the tumor mass as related to diagnosis?