Symptoms and Signs – Differential Diagnosis of Peau d'orange

Symptoms and Signs – Differential Diagnosis of Peau d'orange
Peau d’orange, characterized by edematous thickening and pitting of breast skin, is typically a late manifestation of breast cancer. This gradually emerging symptom may also manifest in cases of breast or axillary lymphadenitis, erysipelas, or Graves' disease. The pronounced orange peel look results from lymphatic edema surrounding the recessed hair follicles.

Medical History and Physical Assessment Inquire with the patient regarding the initial observation of peau d’orange. Has she observed lumps, discomfort, or other alterations in her breasts? Does she exhibit associated signs and symptoms, including malaise, myalgia, and weight loss? Is she now lactating, or has she recently weaned her child? Has she undergone prior axillary surgery that may have compromised lymphatic drainage of a breast?

Acknowledging Peau d'orange In peau d’orange, the skin exhibits a pitted appearance. This condition typically signifies advanced breast cancer. In a well-illuminated examination room, assess the patient's breasts. Assess the magnitude of the peau d’orange and evaluate for erythema. Evaluate the nipples for exudate, misalignment, retraction, indentation, and fissuring. Carefully examine the peau d’orange region, observing for warmth or induration. Subsequently, palpate the entire breast, observing for fixed or movable masses, and examine the axillary lymph nodes for any enlargement. Ultimately, measure the patient's temperature.

Etiological Factors
Breast abscess
Typically impacting nursing mothers with milk stasis, breast abscess results in peau d’orange, malaise, breast discomfort, erythema, and an abrupt fever perhaps accompanied by rigors. A fissured nipple may yield a purulent exudate, and an indurated or discernible soft mass may be evident.

Breast carcinoma
Advanced breast cancer is the predominant etiology of peau d’orange, typically initiating in the inferior region of the breast or the areola. Palpation generally uncovers a solid, fixed mass that is attached to the skin over the region exhibiting peau d’orange. Breast inspection may disclose alterations in contour, size, or symmetry. Examination of the nipples may disclose deviation, erosion, retraction, and a thin, watery, bloody, or purulent discharge. The patient may have a burning and itchy sensation in the nipples, along with a feeling of warmth in the breast.

Breast pain may manifest; however, it is not a dependable predictor of malignancy. Given that peau d’orange typically indicates advanced breast cancer, offer emotional support to the patient. Urge her to articulate her apprehensions and anxieties. Explicitly delineate anticipated diagnostic procedures, including mammography and breast biopsy.

Detail the necessary diagnostic tests for the patient and instruct her on performing monthly breast self-examinations. Identify the signs and symptoms that require her reporting.