The Pushing Sign for Early Skin Tethering in Breast Cancer

Skin tethering (ST) is regarded as a classical clinical feature of breast cancer. In many cases, ST is not evident on inspection, with the arm raised and skin pinching over the lump. We have observed that pushing the lump in one or another direction may elicit skin dimpling that was not otherwise evident. In these cases, there is normal fat, grossly and histologically, between the tumor and the skin. Thus, the dimpling is not due to cutaneous infiltration. We believe that it is caused by tumor involvement of the ligaments of Cooper and present suggestions as to why it might be so. It may be that this is very early involvement of these ligaments, long before ST becomes very obvious. We report our experience with six such cases.