ABSTRACT
BACKGROUND: Cutaneous pathology on the male chest has a broad differential diagnosis that includes both malignant and benign processes. Surgeons-including surgical oncologists, dermatologic surgeons, plastic surgeons, and thoracic surgeons-may be consulted for management or evaluation of these conditions at various stages of the diagnostic work-up. No single surgical specialty manages all cutaneous pathology that arises on the male chest. CASE REPORT: To illustrate the challenges and utility of imaging for diagnosis in the male breast, a clinical example is provided of an 82-year-old male who presented with an ulcerated plaque on the chest with involvement of the nipple areolar complex. The patient underwent shave biopsy and was initially diagnosed with basal cell carcinoma; however, after resection he was found to have invasive mammary carcinoma. CONCLUSION: Careful assessment, investigation, and understanding of pathology that may present on the male chest are key to making the correct diagnosis and avoiding treatment delays.
Subject(s)
Breast Neoplasms, Male , Skin Neoplasms , Humans , Male , Aged, 80 and over , Breast Neoplasms, Male/pathology , Breast Neoplasms, Male/diagnosis , Breast Neoplasms, Male/surgery , Skin Neoplasms/pathology , Skin Neoplasms/diagnosis , Diagnosis, Differential , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/diagnosis , BiopsyABSTRACT
PURPOSE: Unnecessary axillary surgery can potentially be avoided in patients with DCIS undergoing mastectomy. Current guidelines recommend upfront sentinel lymph node biopsy during the index operation due to the potential of upstaging to invasive cancer. This study reviews a single institution's experience with de-escalating axillary surgery using superparamagnetic iron oxide dye for axillary mapping in patients undergoing mastectomy for DCIS. METHODS: This is a retrospective single-institution cross-sectional study. All medical records of patients who underwent mastectomy for a diagnosis of DCIS from August 2021 to January 2023 were reviewed and patients who had SPIO injected at the time of the index mastectomy were included in the study. Descriptive statistics of demographics, clinical information, pathology results, and interval sentinel lymph node biopsy were performed. RESULTS: A total of 41 participants underwent 45 mastectomies for DCIS. The median age of the participants was 58 years (IQR = 17; range 25 to 76 years), and the majority of participants were female (97.8%). The most common indication for mastectomy was diffuse extent of disease (31.7%). On final pathology, 75.6% (34/45) of mastectomy specimens had DCIS without any type of invasion and 15.6% (7/45) had invasive cancer. Of the 7 cases with upgrade to invasive disease, 2 (28.6%) of them underwent interval sentinel lymph node biopsy. All sentinel lymph nodes biopsied were negative for cancer. CONCLUSION: The use of superparamagnetic iron oxide dye can prevent unnecessary axillary surgery in patients with DCIS undergoing mastectomy.