What happened, in summary

A 56-year-old woman was diagnosed in February 2015 with multifocal right breast cancer. Pathology showed two grade 2 invasive ductal carcinomas measuring 48 mm and 12 mm, with lymphovascular invasion. The tumours were oestrogen- and progesterone-receptor positive and HER2 negative. She also had longstanding hidradenitis suppurativa affecting her axillae and groins, which complicated wound care. In March 2015, she underwent mastectomy and axillary node clearance; 1 of 16 lymph nodes contained cancer. The surgical wound opened and healed slowly, with malodour and infection requiring antibiotics, antiseptic soaks, and topical treatment. She declined adjuvant chemotherapy, and radiation was deferred because healing continued for 8 months. She started anastrozole. In July 2019, a mass near the mastectomy scar was biopsied and confirmed recurrent breast cancer. It was removed the next month, but tumour remained at the deep margin. Imaging also found a suspicious, FDG-avid lesion in the left ischium, which was treated with stereotactic ablative radiotherapy in three fractions. Endocrine therapy was changed to exemestane. Because of the positive chest-wall margin and high local-recurrence risk, she received 50.4 Gy of chest-wall radiation in 28 daily fractions over 5.5 weeks in February 2020. She developed areas of moist skin peeling, but her hidradenitis did not flare. The irradiated skin healed completely within 5 weeks, and she continued multidisciplinary follow-up.