{'fraction_non_alphanumeric': 0.022113943028485756, 'fraction_numerical': 0.006746626686656672, 'mean_word_length': 5.385167464114833, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Carcinoma erysipeloides as the presenting feature for bilateral breast carcinoma

Carcinoma erysipeloides is a rare form of cutaneous metastasis. Cutaneous metastases occur in 5.3% of patients with cancer and up to 20% of patients with breast cancer and usually develop within 3 years of diagnosis. Carcinoma erysipeloides accounts for 3% of all cutaneous metastases. It presents as a fixed well-demarcated erythematous patch or plaque resembling cellulitis or erysipelas. Differential diagnoses include cellulitis, eczema, inflammatory breast cancer, radiation dermatitis and mammary Paget disease. Mammary Paget disease presents with eczema-like changes of the nipple and adjacent areas; however, on biopsy, there are Paget cells in the epidermis compared to the dermal infiltrate of malignant cells in carcinoma erysipeloides. A 74-year-old woman presented to a dermatologist with bilaterally retracted nipples, mild surrounding erythema and induration and mild tenderness (Fig. 1). There was no lymphadenopathy or palpable breast lump. She was otherwise well. She had a history of right-sided breast cancer treated 20 years prior with lumpectomy and radiotherapy. Nine months earlier, she developed right-sided nipple retraction and surrounding redness. Her GP started her on antibiotics and referred her for a mammogram and ultrasound which showed non-specific changes and no mass. After five courses of antibiotics and no improvement, her GP referred her to a breast surgeon who advised repeat imaging in three months. The follow-up ultrasound showed a small mass in the right breast. A core biopsy showed no evidence of neoplasia. She later developed similar changes on her left breast, and her GP referred her to the dermatologist. Incisional biopsies from both breasts showed a malignant cellular infiltrate in the superficial to deep dermis and invading into the superficial subcutis, multiple mitoses and lymphovascular invasion consistent with metastatic adenocarcinoma of breast origin. The median survival for all forms of cutaneous metastases in breast cancer is 13.8 months with a 3.1% 10-year survival rate. Treatments include surgery, chemotherapy, hormonal therapies and radiotherapy. Topical chemotherapeutic agents can be useful in small thin carcinomas. Electrochemotherapy combines pulses of electric current and intralesional or systemic chemotherapy agents. Photodynamic therapy is another option. In summary, our patient presented with a rare form of cutaneous metastatic breast carcinoma, carcinoma erysipeloides, which is diagnosed by skin biopsy. She underwent bilateral mastectomy and will be considered for chemotherapy and radiotherapy.