Usually a late sign of breast cancer, peau d’orange (orange peel skin) is the edematous thickening and pitting of breast skin. This slowly developing sign can also occur with breast or axillary lymph node infection, erysipelas, or Graves’disease. Its striking orange peel appearance stems from lymphatic edema around deepened hair follicles. (See Recognizing peau d’orange, page 478.)
Ask the patient when she first detected peau d’orange. Has she noticed lumps, pain, or other breast changes? Does she have related signs and symptoms, such as malaise, achiness, and weight loss? Is she lactating, or has she recently weaned her infant? Has she had previous axillary surgery that might have impaired lymphatic drainage of a breast?
In a well-lit examining room, observe the patient’s breasts. Estimate the extent of the peau d’orange and check for erythema. Assess the nipples for discharge, deviation, retraction, dimpling, and cracking. Gently palpate the area of peau d’orange, noting warmth or induration. Then palpate the entire breast, noting fixed or mobile lumps, and the axillary lymph nodes, noting enlargement. Finally, take the patient’s temperature.
Usually affecting lactating women with milk stasis, breast abscess causes peau d’orange, malaise, breast tenderness and erythema, and a sudden fever that may be accompanied by shaking chills. A cracked nipple may produce a purulent discharge, and an indurated or palpable soft mass may be present.
Advanced breast cancer is the most likely cause of peau d’orange, which usually begins in the dependent part of the breast or the areola. Palpation typically reveals a firm, immobile mass that adheres to the skin above the area of peau d’orange. Inspection of the breasts may reveal changes in contour, size, or symmetry. Inspection of the nipples may reveal deviation, erosion, retraction, and a thin and watery, bloody, or purulent discharge. The patient may report a burning and itching sensation in the nipples as well as a sensation of warmth or heat in the breast. Breast pain may occur, but it isn’t a reliable indicator of cancer.
Because peau d’orange usually signals advanced breast cancer, provide emotional support for the patient. Encourage her to express her fears and concerns. Clearly explain expected diagnostic tests, such as mammography and breast biopsy.
Read excerpts from these other book chapters related to Breast rash:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1 
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