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Case 185: Breast lesion

A 60 year old woman presents with a lesion on her right breast. She thinks it started as an insect bite but has been getting progressively worse over the last 6 months.

1. What is the diagnosis?

This appears to be a locally advanced carcinoma of the right breast. It is stage T4b at least.

2. What investigations would you arrange?

The diagnosis should be confirmed with mammography and core biopsy of the lesion. Then ffter appropriate history and examination to detect regional and systemic metastases she should undergo thorough staging. This includes FBE, LFTs and serum calcium. Imaging with bone scan and CT chest and abdomen would be appropriate with other investigations as directed by the clinical findings.

3. What are the principles of management?

After staging there should be discussion in a multidisciplinary setting to plan therapy which takes into account the patient's overall condition and wishes.

Locally advanced tumours are typically treated with neoadjuvant chemotherapy and hormonal therapy followed by mastectomy and axillary clearnce to obtain locoregional disease control.