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Dermoscopy of skin metastases from breast cancer and of the orange peel type (“peau d'orange”): a report of two cases

To date, no results of any dermoscopy of breast cancer metastases of the orange peel type (peau d’orange) have yet been published. Dermoscopy is a safe, worthwhile, and efficient diagnostic method – not only in the case of diagnosing melanocytic skin tumors but also in reference to the observation of non-melanocytic ones, especially those characterized by pink nodular lesions. A number of literary references exist concerning dermoscopic reports, with their diagnostic steps being based on vascular structures in skin non-melanocytic tumors. However, only a limited number of dermoscopic images of metastic nodules of solid tumors have been published so far. All types of cancer may metastasize to the skin, with the frequency of occurrence ranging from 0.2 to 9% among autopsies carried out on patients with cancer. Skin metastases may occur synchronously or metachronously with the diagnosis of the primary tumor. They usually signify symptoms of advanced cancer. Occasionally, skin metastases may represent an initial manifestation of an occult internal carcinoma. The incidence of skin metastases depends on the type of primary tumor and on the patient’s gender. Breast and lung cancer are the most common primary types of cancer that metastasize to the skin, both among men as well as women. Large intestine cancer, melanoma, head and neck cancer, kidney cancer, stomach cancer, and ovarian cancer have also regularly been known to metastasize to the skin. The clinical diagnosis is not clear. Skin lesions occur as a non-painful, single or multiple, hard or flexible, tiny, pinkish nodule without any specific clinical diagnostic criteria. In such cases, dermoscopy may provide a useful method for the differentiation between the diagnosis of metastasis to the skin and non-neoplastic dermatological diseases.