Peau d'orange

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 606.)

History and physical examination

Ask the patient when she first detected peau d’orange. Has she noticed any 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. Palpate the entire breast, noting any fixed or mobile lumps, and the axillary lymph nodes, noting enlargement. Take the patient’s temperature.

Medical causes

Breast abscess

Usually affecting lactating women with milk stasis, this infectious disorder 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.

Breast cancer

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.

Erysipelas

This streptococcal infection causes a well-demarcated erythematous elevated area, typically with a peau d’orange texture. Pain, warmth, and generalized signs and symptoms, such as fever and fatigue, also occur.

Graves’ disease

Patients with this thyroid disorder may exhibit raised, thickened, hyperpigmented, peau d’orange-like areas that tend to coalesce. Other common signs and symptoms of hyperthyroidism include weight loss, palpitations, anxiety, heat intolerance, tremor, and amenorrhea.

Tuberculosis of the axillary lymph nodes

Peau d’orange occasionally occurs as one or more axillary lymph nodes enlarge.

Special considerations

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.

Pictures

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Breast symptoms: Introduction (review 210 causes)
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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

 » Next page: Breast nodule [Breast lump] (Professional Guide to Signs & Symptoms (Fifth Edition))

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