Diverse Presentations of Carcinoma Erysipelatoides from a Teaching Hospital in Australia

Inflammatory breast carcinoma is a rare form of advanced breast cancer which carries a poor prognosis, even with treatment. Diagnosis is reached on clinical and pathological grounds; however, due to its propensity to mimic other conditions, it may often be delayed or missed by attending physicians. This case series describes four patients seen at our institution with a diagnosis of inflammatory breast cancer; 3 patients had a history of previously treated breast malignancy. In these cases, the emergence of a new breast lesion evaded initial diagnosis due to incomplete initial physical examination, falsely reassuring imaging results, lack of recognition that a cellulitis picture can resemble metastatic carcinoma, and inconclusive initial biopsy sections. These obstacles to achieve diagnosis serve to further worsen the prognosis by delaying the initiation of multimodality treatment which can improve survival. The purpose of our paper is to increase awareness among breast cancer specialists of the importance of undressing the patient for basic clinical examination of the breasts, recognition of the appearances of this type of local recurrence of breast cancer, and not to rely purely on ultrasound and mammography due to delay in diagnosis in some of our local cases. Sometimes deeper sections and repeat biopsies are needed to make the diagnosis. 1. Introduction Inflammatory breast carcinoma, or carcinoma erysipelatoides (CE), is a rare and aggressive form of breast carcinoma with a rapidly progressive course. It has an incidence of 1%–6% of all breast cancer presentations in the United States, a rate which has doubled in the past 20 years [1]. Higher incidences are found in African Americans, who are also diagnosed at a younger age and have a poorer outcome [2]. Overall, CE constitutes 2% of all invasive breast tumours. The average age of onset is 45–54 years [3]. We report a series of four breast cancer patients who presented with inflammation of the skin around the chest, arm, or back, leading to an eventual diagnosis of inflammatory breast carcinoma. 2. Cases 2.1. Case 1 A 62-year-old woman with a history of silicone breast augmentation presented with a nine-month history of erythema of the right arm and upper chest. A breast review had been undertaken, and an ultrasound was normal. She had previously been admitted twice to another hospital with a provisional diagnosis of cellulitis of her right arm, however, remained unresponsive to antibiotic therapy, prompting referral to dermatology by her local doctor. On examination, the right breast was raised