Painful, non-healing ulcer

Presenter: Jeffrey Kushner

Dermatology Program: Saint Joseph Mercy Health System

Program Director: Daniel Stewart

Submitted on: July 18, 2016

CHIEF COMPLAINT: Ulcer on her right breast x 3 weeks

CLINICAL HISTORY: A 63-year-old woman presented with a three-week history of an ulcer on her right breast. The ulcer was painful and non-healing. Application of topical mometasone cream provided no improvement. Past medical history included poorly differentiated invasive ductal carcinoma of the right breast status post lumpectomy, localized radiation therapy, and adjuvant chemotherapy with docetaxel and cyclophosphamide. Her final radiation treatment was one year prior to the onset of symptoms and was complicated by acute radiation dermatitis.

PHYSICAL EXAM:
Physical examination of the right breast revealed a sclerotic plaque with a 1.5 cm central ulceration with overlying fibrinous exudate and surrounding erythema and mottled pigmentation.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

Punch biopsy of the right breast demonstrated a hyperplastic epidermis with increased eosinophils and fibrosis of dermal collagen bundles accompanied by a slight perivascular lymphoplasmacytic infiltrate. Mild vascular ectasia of the superficial dermal vessels was present. There was a lack of vascular wall thickening and stellate fibroblasts were absent