What happened, in summary

An 84-year-old woman with a history of lobular breast cancer and prior left mastectomy presented with a large hardened rash across the front of her chest and chronic painful ulcers on both lower legs. Her breast cancer had previously been in remission, while the leg ulcers had been treated for years as venous disease and repeatedly worsened after debridement and infection.

A biopsy of the chest-wall plaque showed recurrent cutaneous lobular carcinoma with lymphovascular invasion. The lower-leg biopsies, together with the clinical pattern, supported pyoderma gangrenosum rather than cancer in the legs. Dermatology treatment with gentle wound care and oral prednisone led to about a 50% improvement in the ulcers.

Radiation therapy for the recurrent breast cancer was discussed. However, the coronavirus pandemic disrupted further treatment, and no additional cancer therapy was started before she died soon afterward. The case highlighted the simultaneous management of recurrent breast cancer and a severe inflammatory skin condition, while also showing how repeated surgical debridement can worsen pyoderma gangrenosum.