Inflammatory Breast Cancer Diagnosis and Clinical Significance

Clinical Presentation and Diagnosis

The National Comprehensive Cancer Network recommends that orange peel skin (peau d'orange) is a classic clinical sign of inflammatory breast cancer, characterized by dermal edema causing skin dimpling around hair follicles 1, 2
Inflammatory breast cancer is a rare but aggressive form of breast cancer accounting for 1-6% of breast cancer cases in the United States, according to the National Comprehensive Cancer Network 2, 3
The American College of Radiology and the National Comprehensive Cancer Network suggest that IBC is clinically diagnosed when erythema and dermal edema (peau d'orange) affect at least one-third of the breast skin with a palpable border to the erythema 3, 4
The characteristic appearance of IBC is caused by blockage of dermal lymphatics by tumor emboli, not by true inflammation, as stated by the National Comprehensive Cancer Network 4

The National Comprehensive Cancer Network recommends that any patient presenting with breast skin changes resembling orange peel should undergo immediate evaluation with bilateral diagnostic mammogram with or without ultrasound imaging 2, 3
Even with normal imaging findings (BI-RADS 1-3), further evaluation is warranted due to the high association with malignancy, according to the National Comprehensive Cancer Network 2, 3
Punch biopsy of the skin should be performed when imaging findings are consistent with BI-RADS 1-3, as recommended by the National Comprehensive Cancer Network 2, 3
If imaging findings are consistent with BI-RADS 4-5, core needle biopsy with or without punch biopsy is recommended by the National Comprehensive Cancer Network 2, 3

The Infectious Diseases Society of America notes that in skin and soft tissue infections, superficial cutaneous edema surrounding hair follicles can create an orange peel appearance 1, 6
This can be seen in cellulitis and erysipelas, which are diffuse spreading skin infections, according to the Infectious Diseases Society of America 1, 6
Predisposing factors for these infections include obesity, previous cutaneous damage, and edema from venous insufficiency or lymphatic obstruction, as stated by the Infectious Diseases Society of America 1