Photo Quiz: A Persistent Rash on the Back, Chest, and Abdomen

Inflammatory breast cancer is a rare subtype of locally advanced primary breast cancer, accounting for roughly 2.5% of breast cancers in the United States.1 It is characterized by the disruption of dermal lymphatics with tumor emboli, leading to diffuse skin erythema, ulceration, and edema.2 It is commonly high grade, estrogen receptor negative, and progesterone receptor negative, and it often affects younger patients.3 Onset of symptoms can be rapid over days to weeks. Inflammatory breast cancer is an aggressive carcinoma with a five-year survival rate of roughly 50% even with multimodal therapy.1 Poor prognostic factors include metastasis to lymph nodes, extensive erythema, estrogen receptor-negative disease, and the TP53 gene mutation.4 This highly malignant cancer is often misdiagnosed as a benign infectious or inflammatory process and can also mimic other tumors, such as sarcomas.5 Mycosis fungoides is the most common form of cutaneous T cell lymphoma. Summary Table Condition Characteristics Inflammatory breast cancer Skin erythema, ulceration, and edema; punch biopsy shows breast tumor pathology Mycosis fungoides Rash-like patches or lesions that may be pruritic; biopsy shows cutaneous T cell lymphoma Radiation dermatitis Recent radiation exposure; acute: blisters, erythema; chronic: atrophic indurated plaques that are typically white or yellow Tinea corporis Red, scaly, pruritic rings that appear raised and dry Address correspondence to Derek D. Kane, MD, MS, at dkane@primecare.org.