Breast ulcer

Appearing on the nipple, areola, or the breast itself, an ulcer indicates destruction of the skin and subcutaneous tissue. A breast ulcer is usually a late sign of cancer, appearing well after the confirming diagnosis. However, it may be the presenting sign of breast cancer in men, who are more apt to dismiss earlier breast changes. Breast ulcers can also result from trauma, infection, or radiation.

History and physical examination

Begin the history by asking when the patient first noticed the ulcer and if it was preceded by other breast changes, such as nodules, edema, or nipple discharge, deviation, or retraction. Does the ulcer seem to be getting better or worse? Does it cause pain or produce drainage? Has she noticed any change in breast shape? Has she had a rash? If she has been treating the ulcer at home, find out how.

Review the patient’s personal and family history for factors that increase the risk of breast cancer. For example, ask about previous cancer, especially of the breast, and mastectomy. Determine whether the patient’s mother or sister has had breast cancer. Ask the patient’s age at menarche and menopause because more than 30 years of menstrual activity increases the risk of breast cancer. Also ask about pregnancy because nulliparity or a first pregnancy after age 30 also increases the risk of breast cancer.

If the patient recently gave birth, ask if she breast-feeds her infant or has recently weaned him. Ask if she’s currently taking an oral antibiotic and if she’s diabetic. All these factors predispose the patient to candidal infections.

Inspect the patient’s breast, noting any asymmetry or flattening. Look for a rash, scaling, cracking, or red excoriation on the nipples, areola, and inframammary fold. Check especially for skin changes, such as warmth, erythema, or peau d’orange. Palpate the breast for masses, noting any induration beneath the ulcer. Then carefully palpate for tenderness or nodules around the areola and the axillary lymph nodes.

Medical causes

Breast cancer

A breast ulcer that doesn’t heal within 1 month usually indicates cancer. Ulceration along a mastectomy scar may indicate metastatic cancer; a nodule beneath the ulcer may be a late sign of a fulminating tumor. Other signs include a palpable breast nodule, skin dimpling, nipple retraction, bloody or serous nipple discharge, erythema, peau d’orange, and enlarged axillary lymph nodes.

Breast trauma

Tissue destruction with inadequate healing may produce breast ulcers. Associated signs depend on the type of trauma but may include ecchymosis, lacerations, abrasions, swelling, and hematoma.

Candida albicans

A severe candidal infection can cause maceration of breast tissue followed by ulceration. Well-defined, bright-red papular patches—usually with scaly borders—characterize the infection, which can develop in the breast folds. Cracked nipples predispose breast-feeding women to this infection, which causes a burning pain that penetrates into the chest wall when the infant sucks.

Paget’s disease

Bright-red nipple excoriation can extend to the areola and ulcerate. A serous or bloody nipple discharge and extreme nipple itching may accompany ulceration. Symptoms are usually unilateral.

Other causes

Radiation therapy

After radiation, the breasts appear “sunburned.” Subsequently, the skin ulcerates and the surrounding area becomes red and tender.

Special considerations

Because breast ulcers become infected easily, teach the patient how to apply topical antifungal ointment or cream. Instruct her to keep the ulcer dry to reduce chafing and to wear loose-fitting undergarments. If breast cancer is suspected, provide emotional support and encourage the patient to express her feelings. Prepare her for diagnostic tests, such as ultrasonography, thermography, mammography, nipple discharge cytology, and breast biopsy. If a candidal infection is suspected, prepare her for skin or blood cultures.

Geriatric pointers

Breast ulcers should be considered cancerous until proven otherwise in elderly women because of their increased breast cancer risk. However, ulcers can also result from normal skin changes in the elderly, such as thinning, decreased vascularity, and loss of elasticity as well as from poor skin hygiene. Pressure ulcers may result from the use of restraints or tight bras; traumatic ulcers, from falls or abuse.

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.

Other Book Chapters Related to Breast symptoms

Read excerpts from these other book chapters related to Breast symptoms:

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

More About Causes of Breast symptoms

• Back to symptom: Breast symptoms: Introduction (review 210 causes)
• Next Book Extract About Breast symptoms: Nipple Discharge (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• All Book Extracts: All Online Book Extracts for Breast symptoms

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: Nipple Discharge (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

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