Recurrent Breast Cancer With a Benign-Appearing Chest-Wall Rash

What happened, in summary

A 51-year-old woman was diagnosed in 1998 with a 1.5 cm grade 2 invasive ductal carcinoma of the breast with associated ductal carcinoma in situ. The cancer was estrogen-receptor positive, progesterone-receptor negative, and HER2-negative. She underwent lumpectomy, six cycles of cyclophosphamide, methotrexate, and 5-fluorouracil, and whole-breast radiation to 50.4 Gy with a 10 Gy boost.

At age 62, she developed a 1.3 cm cancer in the same breast with extensive dermal invasion. Treatment included mastectomy, four cycles of paclitaxel and carboplatin, and letrozole. The disease later returned in the chest wall and spread to mediastinal lymph nodes. She received additional radiation to the mediastinum and axilla, 30 Gy in 10 fractions.

Five months after that radiation course, she developed a rash across the right chest wall and swelling of the arm. Because of her history of repeated local recurrence, the new skin findings raised concern for further cancer involvement. Biopsy instead showed superficial perivascular dermatitis without malignancy.

She continued living with recurrent and metastatic breast cancer while treatment-related skin changes required careful evaluation. The rash itself was not another documented recurrence, and the arm swelling was managed as lymphedema.