The breast is yet to come (to your office)
Dermatologists should be ready to treat skin diseases of the breast.
F022 – Behind the Bra: What Dermatologists Should Know About Diseases of the Breast
Friday, March 17 | 1-3 p.m.
Room 391
When was the last time you saw a patient with idiopathic granulomatous mastitis? For many dermatologists, the answer is “never,” even though this inflammatory disease of breast skin is treated with familiar, anti-inflammatory agents.
“There are conditions like idiopathic granulomatous mastitis that breast surgeons see more than we do,” said Miriam K. Pomeranz, MD, FAAD, associate professor of dermatology at New York University Grossman School of Medicine and chief of dermatology at Bellevue Hospital. She and a panel of other experts will present the new session, “F022 –Behind the Bra: What Dermatologists Should Know About Diseases of the Breast” today at 1 p.m.
Sensitive sites
“Breast surgeons are the most common clinicians involved, but dermatologists can step in and be very helpful,” Dr. Pomeranz said. “And there are fewer common conditions like diffuse dermal angiomatosis, but pendulous breasts are a common site. It can cause significant discomfort and can look like inflammatory breast cancer, but it’s a dermatologic condition, just one of many skin diseases of the breast that are likely under-recognized.”
Gender issues
Inflammatory diseases of the breast as well as infectious and neoplastic entities affect many dermatology patients. Procedures most often seen in patients who are transgender or gender non-binary can have dermatologic sequelae.
“Transgender men sometimes bind their breasts to appear more masculine, which can lead to dermatosis,” Dr. Pomeranz noted. “People having top surgery can become very self-conscious about the scarring, and dermatologists are the leading experts in minimizing and treating scars. That’s just one set of many areas we are becoming involved in — or should be.”
Be ready to answer the call
One of the complications, Dr. Pomeranz said, is that many patients start their journey with a breast specialist who refers them to the dermatologist. Women with granulomatous mastitis typically go to a breast surgeon with what looks like an abscess or inflammatory breast cancer. Once surgeons realize it is not a malignant or infectious condition, they might refer them to dermatology.
“It’s important to know your referring specialists and have good lines of communication,” Dr. Pomeranz said. “A patient with diffuse dermal angiomatosis might come to a dermatologist directly, but it doesn’t happen often.”
Pregnancy, lactation, and other issues
Pregnancy and lactation also increase the likelihood of dermatitis. Breast size typically increases, which can lead to skin problems, particularly irritant dermatitis. Lactation can also give rise to discomfort, irritation, and infection.
“There are other complications that we don’t often think about, like Raynaud’s syndrome,” Dr. Pomeranz said. “We tend to think about Raynaud’s and fingers or toes, but it can occur in the breast as well, leading to a lot of pain and discoloration. Clinicians aren’t always aware that it can happen outside the digits.”
Dermatologists occasionally diagnose breast cancers that present as eczema of the nipple, but they more often see the side effects of chemotherapy or radiation therapy that affect the breast.
Radiation dermatitis can be very uncomfortable, Dr. Pomeranz said, as can post-radiation morphea. Morphea often occurs on the breast but can occur elsewhere as well. Dermatologists are frequently called in to help deal with scarring after breast cancer surgery.
“Patients, particularly women, may be hesitant to discuss or show the dermatologist diseases on the breast,” Dr. Pomeranz said. “They may not initially take their bra off for an exam, so we need to get more comfortable with asking directly if they are having any pain or discomfort. This session will help you get more comfortable with asking about and treating the skin of the breast, including some of the more unusual presentations that may walk into your office.”
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