Diagnosis of three neoplasms to the bilateral lower extremities in the presence of invasive ductal carcinoma of the right breast: A case study

Abstract

Literature reports cutaneous metastatic carcinoma as an uncommon finding. This foreboding phenomenon accounts for 0.7%-9% of metastases and may foreshadow a grim prognostic outcome. Ductal-type breast cancer is associated with an increased incidence of cutaneous metastasis in women. Current literature documents cutaneous malignancy to the chest wall or surrounding anatomic locations however there is no literature that currently details three forms of cutaneous manifestations to the lower extremities.¹

A 62-year-old diabetic female received a routine mammogram yielding an architectural distortion within the right breast. Biopsy revealed infiltrating carcinoma. The patient underwent a mastectomy, axillary sentinel node biopsy and dissection. Pathology results yielded multifocal disease with positive lymph nodes. The patient was placed on an oral chemotherapeutic agent with adjutant radiation. She began outpatient podiatric treatment for venous leg ulcerations with concomitant cellulitis and lymphedema from December 2020 through 2022. The patient noted chronically inflamed and bleeding lesions with slow response to treatment despite use of appropriate modalities including compression, unna boot application, antibiosis, and topical steroids.

In June of 2022, a verrucous outpouching of tissue was noted to the right lateral leg. A punch biopsy yielded irregular glassy islands with keratinocyte atypia consistent with invasive squamous cell carcinoma. Furthermore, the patient was found to have malignant melanoma to her left thigh and recurrent basal cell carcinoma nodular type to the left lateral leg. The patient was referred to dermatology and plastic surgery for excision of lesions with Mohs surgery. She maintains perpetual observation via podiatry, dermatology, and hematology/oncology.