Cutaneous lesions as the first manifestation of breast cancer: a rare case

Cutaneous metastases due to internal malignancies are rare but, in some cases, may present as the first manifestation of an undiagnosed malignancy. A 62-year-old female presented with itchy reddish patch on the left neck which spread to the left shoulder, arm, breast, and back four weeks prior to admission. Ten days later, vesicles emerged, ruptured, and ulcerated. The patient denied any history of breast lump. Skin biopsy showed diffuse dermal nests of tumor cells infiltrating to the collagen bundles and fat tissue, which was consistent with cutaneous metastasis from the breast cancer. The patient refused further workup and treatment and eventually passed away. This case showed the importance of conducting a comprehensive evaluation in cutaneous lesions presenting with early or sudden onset, rapid evolution, tendency to bleed, that do not resolve with treatment.