Today I saw a 65 year-old woman who has ignored a problem with her left breast for several years. When I examined her, I saw a large ulcer (about 10x15 cm) on the chest wall with a necrotic exudate. Perhaps part of the axillary tail of the breast remained, but nothing else. I didn't see any ribs showing, so I assume that the pectoralis muscle was still there.
Oh yeah... there was a large tumor under the nipple of the right breast, which had an inverted retracted nipple which bled. There were no palpable lymph nodes. She is otherwise well, and has no complaints except for pain when she raises her left arm (!). I did a core needle biopsy of the right breast mass.
I haven't seen a breast cancer in several years (they all seem to go to the breast "specialist"). So I will admit that I haven't seen this before. I ordered a bone scan and chest x-ray. I will send her to the medical oncologist for chemotherapy.
My question to our consultants: What will happen to the ulcer on the chest wall? Will chemotherapy eradicate the tumor? If so, will the wound clean itself up? Will she ever be a candidate to have the chest wall closed, presumably by some type of rotation flap? At this point, I can't imagine doing anything to the left side. The wound looks horrible, though I see nothing to debride.