Secondary breast cancer in the skin (skin metastases)

When cancer that started in the breast spreads to or just below the skin, it’s called secondary breast cancer in the skin. Some people refer to it as skin metastases.

The cells that have spread to the skin are breast cancer cells. It’s not the same as having cancer that starts in the skin.

Breast cancer cells can spread to the skin through the lymphatic system or the blood.

Skin metastases are different to local recurrence, which is when primary breast cancer has come back in the chest or breast area or in the skin near the original site or scar. Although some of the symptoms may be similar, having local recurrence doesn't mean the cancer has spread. The aim of treatment for local recurrence is still to remove all the cancer and to reduce the risk of cancer affecting other parts of the body in the future.

Symptoms of secondary breast cancer in the skin include:

• A change in the colour of the skin
• A lasting rash
• A firm, painless, small lump (nodule) or several lumps of different sizes

Sometimes the symptoms of secondary breast cancer in the skin, such as redness and inflammation, may look like an infection of the skin called cellulitis.

Secondary breast cancer in the skin can also cause lymphoedema, which is swelling of the arm, hand or breast area.

Other symptoms can include:

• Pain
• Bleeding
• Infection, which can cause an unpleasant smell if the skin has broken down

The most common places to have secondary breast cancer in the skin are the areas near the site of the breast cancer, for example the skin of the chest wall, around the surgical scar or the tummy.

Less commonly, secondary breast cancer in the skin can happen in other places, such as on the scalp, neck, back and arms.

If you’ve been told you have secondary breast cancer, you may want to know how long you’ve got to live.

As treatments have improved, more and more people are living much longer after their diagnosis of secondary breast cancer.

However, life expectancy is difficult to predict. Each person’s case is different, and no 2 cancers progress or respond to treatment in the same way.

Your treatment team can talk to you about how your secondary breast cancer may progress.

You may worry if their answers are vague, but it’s very difficult to accurately predict how each person’s cancer will respond to treatment.

You can read our information for people newly diagnosed with secondary breast cancer.

Your treatment team will examine you and look at your skin. They’ll also discuss any other symptoms you have.

Punch biopsy

To confirm a diagnosis of secondary breast cancer in the skin, you may have a punch biopsy. This involves taking a very small circle of tissue from the area. You’ll be given a local anaesthetic (medication to numb the area). The area might bleed a little after the biopsy, so a small dressing or plaster will be applied.

The biopsy site may be uncomfortable for a little while, but you can take simple pain relief like paracetamol or ibuprofen to help with this.

CT scan

You may also have a CT scan to check for any signs of the cancer having spread to other parts of the body.

A CT scan uses x-rays to take a series of detailed pictures of the body. It’s painless but during the CT scan you have to lie still for around half an hour. You may have dye injected into a vein, usually in your arm, before you have the scan. This is so different areas of the body can be seen more clearly. 

When breast cancer spreads to the skin, it can be treated but it cannot be cured. The aim of treatment is to relieve symptoms, improve quality of life and slow the growth of the cancer.

The treatment you’re offered will depend on several things, such as:

• Your symptoms
• The type and features of the cancer
• If the cancer has spread to other areas of the body
• Treatments you have had in the past
•  Your general health

Your treatment team will discuss treatment options with you, help you weigh up the potential benefits against possible side effects and explain what the aim of treatment will be for you.

Your treatment may include:

• Chemotherapy
• Targeted therapies
• Hormone (endocrine) therapy

Treatments specifically for your skin may include:

• Specialist dressings
• Surgery
• Radiotherapy
• Electrochemotherapy (see below)
• Antibiotics
• Pain relief

These treatments can be given alone or together in combination.

What is electrochemotherapy?

Electrochemotherapy (sometimes called ECT) is a treatment for secondary breast cancer that has spread to the skin. It combines a low dose of a chemotherapy drug with electrical impulses. The electrical impulses are given using an electrode directly to the areas being treated. This allows the chemotherapy to work in the treatment areas only, with little to no effect in other areas.

Studies have shown that electrochemotherapy can:

• Help stop bleeding, broken skin (ulceration) and pain
• Reduce the size of skin metastases

Electrochemotherapy will not treat any other areas of secondary breast cancer inside the body.

Who might be offered electrochemotherapy?

You may be offered electrochemotherapy if other treatments have not worked or if surgery isn’t suitable.

You will need several tests to make sure it’s safe to give you electrochemotherapy. These may include:

• Blood tests
•  A chest x-ray
•  A CT scan of the chest
• Lung function tests

Your specialist can tell you if electrochemotherapy is suitable for you. You may need to travel to a different hospital to have electrochemotherapy.

You can have electrochemotherapy alongside other treatments or to skin which has previously been treated with radiotherapy.

Electrochemotherapy may not be suitable for some people with certain lung conditions.

How does it work?

Electrical impulses change the outer layer of the cancer cells in the treated area. This causes gaps, called pores, to open on the cells’ surface for a short time. This allows the chemotherapy drug to enter the cancer cells more easily. Once the pores close, the chemotherapy is sealed inside the cells.

The dose of the chemotherapy drug is much lower than when it’s given to treat the whole body.

[H3] How is electrochemotherapy given?

The chemotherapy is usually given into a vein (intravenously). It can also be given by injection directly into the area of cancer being treated (intratumorally).

Bleomycin is the most common drug used. Cisplatin, another chemotherapy drug, may also be used.

Shortly after you have the chemotherapy drug, electrical impulses are given directly to the area using an electrode with the help of a specially designed needle probe. The electrode may be applied several times to make sure the whole area is treated. The procedure usually takes between 10 and 60 minutes, depending on the size of the area being treated.

You may have electrochemotherapy under general anaesthetic (where you're given medicine so you're asleep (unconscious) and do not feel anything during an operation or procedure) or local anaesthetic (medication to numb the area).

You may only need 1 treatment of electrochemotherapy, although it can be repeated in the same area or used to treat a different area.

Afterwards, the area may be covered with a dressing. Your treatment team will tell you how long to keep this in place. The treated areas will usually scab over. Often the areas look worse before you’ll see any improvement. 

You will usually have electrochemotherapy as an outpatient or day case. However, you might need to stay in hospital overnight. This depends on how much treatment is needed and your general health.

Because the overall dose of chemotherapy is low, people do not usually experience the common side effects of chemotherapy, such as hair loss.

However, electrochemotherapy can cause side effects. Everyone reacts differently to treatment and some people have more side effects than others.

Pain

You may have pain in the area of skin that was treated, and it may feel warm.

The pain may continue for a few weeks but sometimes lasts longer. Let your treatment team know if the pain does not get better. They can prescribe pain relief.

Pain may be worse for people who already have pain caused by secondary breast cancer in the skin, or when particular areas such as the breastbone (sternum) are treated.

Muscle discomfort

Some people have muscle contractions when the electrical impulses are given. These usually stop once treatment is finished but can cause a cramp-like discomfort for a short time afterwards.

Skin changes

It’s common for the skin in the treated area to become lighter or darker in colour. This skin change appears 1 to 2 weeks after treatment. It may fade but is usually permanent.

Less common side effects

Less common side effects include:

• Allergic reaction to the chemotherapy drug
• Bleeding and oozing from the wound, especially if radiotherapy has been given to the area
• Mild temperature, which usually improves with paracetamol
• Infection
• Mild rash
• Redness and swelling
• Scarring
• Lung problems due to side effects from the chemotherapy drug

Some people will have mild effects from the chemotherapy drug, such as feeling sick (nausea) and being sick (vomiting).

Everyone’s experience of being diagnosed with secondary breast cancer is different. For many people, uncertainty can be the hardest part of living with secondary breast cancer.

You may find it helpful to talk to someone else who’s had a diagnosis of secondary breast cancer. Our Living with Secondary Breast Cancer groups meet in person and online and are a chance to explore different topics or just share what’s on your mind. And they’re all facilitated by qualified counsellors.  

And for  women under the age of 45 with secondary breast cancer, our Younger Women with Secondaries Together groups and events are there to support you.

You can also chat to other people living with secondary breast cancer on our online forum.

*Image credit: Adapted from: Sersa et al. Electrochemotherapy in treatment of tumours. European Journal of Surgical Oncology. 2008. 34: 232–240. Adapted by permission under the Creative Commons Attribution-ShareAlike 3.0 license:creativecommons.org/licenses/by-sa/3.0.