From rashes to hair loss, breast cancer can cause skin changes and more.
Breast cancer does not always start with a lump. Often, some of the first warning signs appear on the skin.
Research shows that up to 10% of breast cancer patients are initially diagnosed with skin changes.
Breast cancer treatments can also cause side effects on the skin, hair or nails, which up to 94% of patients experience, studies show.
“Involving a dermatologist early in the process can help establish a baseline and put a plan in place in case side effects arise,” Dr. Kiran Mian, a dermatologist at Hudson Dermatology and Laser Surgery, told ABC News.
When skin changes could be a warning sign of breast cancer
Breast cancer is the most common skin cancer, according to research.
The disease can also cause visible changes to the skin of the breast. Symptoms usually affect one breast and may include discoloration, persistent rash, swelling, warmth, skin that looks like orange peel, and a nipple that turns inward, according to the National Cancer Institute.
These changes can have many causes and do not always mean cancer, but a new or persistent change that does not improve should be evaluated by a doctor.
One type of breast cancer in which skin symptoms may be particularly noticeable is inflammatory breast cancer.
Inflammatory breast cancer, or IBC, is a rare but aggressive type that accounts for 1 to 5 percent of all breast cancers, according to the American Cancer Society. It tends to grow and spread more quickly than the more common types of breast cancer, and it is diagnosed more often in black women and at younger ages.
Because IBC does not usually form a lump, it may not show up on a mammogram and may be confused with a breast infection or an eczema-like rash.
“Sometimes these patients have skin changes rather than a discrete lump,” Dr. Elizabeth Comen, a medical oncologist and breast cancer specialist at NYU Langone Health, told ABC News. “Often patients are given some sort of antibiotic and they don’t improve, and that’s when we often do a punch biopsy.”
Breast cancer treatments that can cause skin changes
Radiation often irritates the skin, causing redness that may look like a sunburn, as well as swelling, itching, and darkening of the skin. At higher doses, the skin may peel and leak fluid.
“For my patients undergoing radiation therapy, the foundation is gentle skin care and generous hydration,” Mian said.
These changes usually develop gradually over the course of treatment and may persist shortly after radiation therapy ends. Patients may be advised to use gentle, fragrance-free products, keep the area moisturized, and avoid anything that further irritates the skin.
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More serious reactions should be discussed with the patient’s cancer care team or a dermatologist.
“It’s not uncommon for patients to have skin toxicities, and sometimes we reduce doses, sometimes we use topical medications,” Comen said.
Dermatologists can work alongside a patient’s cancer team to help manage these symptoms, which can keep patients more comfortable during treatment.
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Hair loss is the side effect that many patients fear the most, with more than 70% of patients reporting it is the most feared side effect, and almost 10% considering refusing chemotherapy because of it, according to research.
“Hair loss is not superficial. It can be an important part of a person’s identity,” Comen said.
Cooling the scalp, which involves wearing a cold cap during chemotherapy, can help limit hair loss. According to one study, up to two-thirds of women who use it retain at least half of their hair.
“We often find that patients are unaware of the option of cold styling, depending on the chemotherapy regimen they are administering, or they assume that all chemotherapy treatments necessarily result in hair loss, which is not true,” Comen said.
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Hair loss can also occur on other parts of the body besides the head.
“Thinning hair as well as eyebrows and eyelashes can be quite distressing.” » said Mian.
Dermatologists can also help patients understand which treatments are appropriate to use during and after cancer treatment.
Post-treatment options may include minoxidil for hair loss and treatments for changes affecting eyebrows, eyelashes, scars or dark spots, she said.
For patients, talking about skin changes can be important both during treatment and before a cancer diagnosis.
“Never be afraid to ask your doctor about a new rash,” Comen said. “Breast cancer does not always appear as a lump.”
Dr. Tara Howard is a fourth-year dermatology resident and member of the ABC News Medical Unit.
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