Breast Skin Changes

Some breast skin changes can appear similar to inflammatory breast cancer or Paget's disease, leading to anxiety about the possibility of cancer. Usually there are other reasons for the skin changes, but we do recommend evaluation, especially if these are new, persistent or worsening.

Skin changes that cause worry include:

  • Skin puckering or dimpling
  • Nipple inversion (when nipples indent, or seem to turn inward)
  • Thickened skin tissue, with enlarged pores (known as peau d'orange, French for orange peel, which it resembles)
  • Warmth, pain or redness of the skin
  • Scaling, thickening or flaking of the nipple or areola (pigmented area around the nipple)

Common causes of skin changes include:

  • Skin puckering or dimpling. Skin puckering or dimpling can be caused by scarring from a previous operation or infection, but in the majority of cases, no specific reason can be found. Most often it is not a sign of underlying cancer, but should be evaluated with exam and imaging. If there is no other abnormality, it does not require treatment.
     
  • Nipple inversion. If nipple inversion has been longstanding, if the nipple can be easily "everted" (making the nipple point outward) and if there are no other symptoms, then it is normal and does not require further treatment. Nipple inversion can be worrisome when it is associated with skin changes, breast mass or abnormal findings on imaging.
     
  • Thickened skin tissue with enlarged pores (known as peau d'orange, French for orange peel, which it resembles in texture). Peau d'orange is often associated with inflammatory breast cancer, which refers to cancer that involves the skin's network of small lymphatic channels (similar to blood vessels). Mastitis (breast infection) can have a similar appearance.
     
  • Warmth, pain, or redness of the skin. This can be caused by mastitis or other infection. Any rash that doesn't go away should be evaluated.
     
  • Scaling or flaking. These skin changes can be associated with eczema or dermatitis (benign skin conditions). Paget's disease, a noninvasive cancer involving the nipple or areola, can rarely be the cause.

Evaluation and follow-up can include:

  • Thorough medical history review and clinical breast exam
  • Mammogram and/or breast ultrasound  
  • Needle biopsy can be suggested, to remove a small piece of tissue to look at under a microscope
  • Possible consultation with a specialist such as breast surgeon or dermatologist
  • Symptom management

Follow-Up

Follow-up is determined by you and your provider depending on your particular situation.

Questions About Breast Skin Changes?

If you have questions about this topic, or would like more information, please talk with your health-care provider. Virginia Mason's Breast Clinic, with locations in Seattle and Federal Way, is easily reached toll-free at (877) 433-9813. We make it a priority to answer your call promptly and to schedule you for the most appropriate exam.