1. What are skin metastases?
Skin metastases are secondary breast cancers that form on or just below the skin.
Secondary breast cancer happens when cancer cells spread from the breast to other parts of the body. Sometimes breast cancer cells can spread to the skin (skin metastases). This can happen through the blood or .
This is not the same as having cancer that starts in the skin. The cells that have spread to the skin are breast cancer cells.
Skin metastases are different to local recurrence, which is when has come back in the chest or breast area. 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.
Tests, including a , will help to confirm skin metastases.
The most common sites affected are the areas near the site of the breast cancer, for example the skin of the chest wall, around the surgical scar or the abdomen (belly).
Less commonly, skin metastases can occur on other areas of skin, such as on the scalp, neck, back and arms.
About a third of people with secondary breast cancer will develop skin metastases.
2. Symptoms of skin metastases
Symptoms of skin metastases can vary, but may include:
- A change in the colour of the skin
- A lasting rash
- A firm, painless, small lump (nodule) or a number of lumps of different sizes
Sometimes the symptoms of skin metastases, such as redness and inflammation, may look like an infection of the skin called cellulitis.
Skin metastases can also cause lymphoedema, which is swelling of the arm, hand or breast area.
Other possible symptoms include:
- Pain
- Bleeding
- Infection
- Smell (odour)
3. Tests for skin metastases
A member of your treatment team will examine you and look at your skin. They’ll also discuss any other symptoms you have.
To confirm a diagnosis of secondary breast cancer in the skin, you may have a punch biopsy. You’ll be given a local anaesthetic before a tiny cutter device is used to take a very small piece of tissue from the area. It’s not unusual for the area to 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 simple pain relief can be taken to help with this.
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 need to lie still for a short period of time. Before the scan you may be given a liquid known as a contrast solution. This is usually injected into a vein, and helps produce clearer images to identify the number, size and location of any areas of cancer.
4. Treatment for skin metastases
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.
Types of treatments
The treatment offered will depend on a number of factors. These include your symptoms, the type and features of the cancer, treatments you have had in the past and 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:
- Specialist dressings
- Surgery
- Electrochemotherapy (see below)
- Pain relief
- Antibiotics
5. Electrochemotherapy
What is electrochemotherapy?
Electrochemotherapy (sometimes called ECT) combines a low dose of a chemotherapy drug with electrical impulses. It’s given to help with the symptoms of skin metastases.
Studies have shown that electrochemotherapy can:
- Help stop bleeding, broken skin (ulceration) and pain
- Reduce the size of skin metastases
Using electrical impulses allows the chemotherapy to work in the treated areas only, with little or no effect in other areas.
Electrochemotherapy won’t treat any other areas of secondary breast cancer inside the body.
When is it given?
Electrochemotherapy may be used to treat skin metastases when other treatments haven’t worked or when surgery isn’t suitable. It will be planned by your treatment team on an individual basis.
It can also be given 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.
You will need a number of tests to ensure it is safe to give you electrochemotherapy. These may include blood tests, a chest x-ray, a of the chest and lung function tests.
You may be asked to have medical photographs taken of the skin metastases and the area that requires treatment before it begins, and once it’s completed. This can help to monitor the affected areas and assess the effectiveness of the treatment.
How does it work?
Electrical impulses change the outer layer of the cancer cells in the treated area causing gaps, called pores, to open up 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.
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 chemotherapy drug most commonly used. Cisplatin, another chemotherapy drug, may also be used.
A short time after the chemotherapy drug is given, 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 a number of times to make sure the whole area is treated. The procedure usually takes about 30 minutes but will depend on the size of the area being treated.
It’s usually given under general anaesthetic in the operating theatre. Sometimes local anaesthetic may be used depending on the size of the area or how many areas need to be treated. As electrochemotherapy treatment can be painful, you will be given pain relief before and after the treatment.
Many people need only a single treatment of electrochemotherapy, although it can be repeated in the same area or used to treat a different area.
Treatment is usually carried out as an outpatient or day case, though some people may need to stay in hospital overnight. This depends on how much treatment is needed and your general health.
Afterwards, the area will often be covered with a dressing that may need changing regularly. The treated areas will usually scab over. Often the areas look worse before any improvement is seen.
Side effects
Because the overall dose of chemotherapy is low, people don’t 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.
Pain may continue for a few weeks but sometimes lasts longer. Let your treatment team know if the pain does not get better. Your doctor can prescribe pain relief.
Pain may be worse for people who already have pain caused by skin metastases, or when particular areas such as the breastbone (sternum) are treated.
Muscle discomfort
Some people have muscle contractions when the electric 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 than before treatment. This skin change appears one to two weeks after treatment and 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 goes down with paracetamol
- Infection
- Mild rash
- Redness and swelling
- Scarring
- Lung problems due to the side effect of the chemotherapy
Some people will have mild effects from the chemotherapy drug, such as feeling sick (nausea) and being sick (vomiting).
Getting treatment
Electrochemotherapy is a relatively new treatment but is now available in an increasing number of hospitals in England, Scotland and Wales.
You can ask your treatment team if this is a suitable treatment option for you. They can refer you to the nearest available location for treatment.
6. Support for living with secondary breast cancer
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.
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.
