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Breast J. 2018 Jan;24(1):41-50. doi: 10.1111/tbj.12830. Epub 2017 Jun 8.

The role of skin ulceration in breast carcinoma staging and outcome.

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Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
Department of Pathology, Washington University, Saint Louis, MO, USA.
Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Department of Pathology, Vanderbilt University, Nashville, TN, USA.
Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Pathology, Ohio State University, Columbus, OH, USA.
Department of Biostatistics, Roswell Park Cancer Institute, Roswell Park Cancer Institute, Buffalo, NY, USA.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.


Breast carcinoma with skin ulceration (SU) is considered a locally advanced disease. The purpose of the study is to investigate if SU is an independent adverse factor. Breast carcinoma patients with SU (n=111) were included in the study. A subset (n=38, study cohort) was matched with cases that had no SU (n=38, matched cohort); the survival analyses were compared between these groups. Then, cases (n=80) were staged independent from SU into stage I, II or III. Disease free survival (DFS) and overall survival (OS) were analyzed. Patients with larger tumors tended to present with distant metastases more often than patients with smaller tumors (P=.004). In the matched cases, the 5-year DFS probability was 53% for the study cohort and 58% for the matched cohort; and for OS 75% for the study cohort and 84% for the matched cohort with no statistical significant difference. However, there was a trend towards worse DFS for the patients whose tumors had SU. When the cases were staged based on tumor size and node status (I, II or III), the OS was statistically significant (P=.047) but not the DFS (P=.195). Relatively small tumors with SU had an extent of disease similar to that observed in patients with early stages disease. The survival analysis suggests that SU may not be an adverse factor. However, more cases are needed to further examine this finding.


breast carcinoma; skin ulceration; staging; survival

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