Breast Skin Dimpling Causes and Diagnostic Approach

Primary Causes

The American College of Radiology suggests that breast cancer is the most common and significant cause of breast skin dimpling, particularly when the tumor involves Cooper's ligaments, causing tethering of the skin without direct tumor invasion of the dermis 1

The European Society for Medical Oncology (ESMO) guidelines indicate that skin changes, including dimpling, may occur in T1, T2, or T3 tumors without changing their classification 2, 3, 4

The National Comprehensive Cancer Network (NCCN) recommends that any patient presenting with breast skin dimpling should undergo bilateral diagnostic mammogram with or without ultrasound imaging, and if imaging findings are classified as BI-RADS 4 or 5, tissue biopsy is recommended 5, 6
The NCCN also suggests that even with normal imaging (BI-RADS 1-3), further evaluation is warranted due to the high association with malignancy 6
The NCCN guidelines clarify that skin dimpling should not be confused with inflammatory breast cancer, which presents with diffuse erythema and edema (peau d'orange) involving a third or more of the breast skin 5, 7

The American College of Radiology notes that breast cancers presenting with skin changes, including dimpling, tend to be more aggressive than screen-detected cancers and often have a poorer prognosis 1
The NCCN guidelines mention that other concerning findings that may accompany skin dimpling include palpable mass, nipple retraction, and asymmetric thickening of breast tissue 1, 6