sarcoidosis ( flesh - like process ) also called sarcoid or besnier - boeck disease is a multisystem disorder of unknown etiology which is characterized by non - caseating granulomas ( small inflammatory nodules ) mainly involving the lungs ( 90% ) , lymph nodes , eyes , and skin . the first reported case bearing the clinicopathological features of subcutaneous sarcoidosis subcutaneous sarcoidosis ( also known as  darier - roussy sarcoid ) is a cutaneous condition characterized by numerous 0.3 to 0.5-cm deep - seated nodules on the trunk and extremities . sarcoidosis most commonly affects young adults of both sexes , although studies have reported more cases in females . incidence is highest in individuals younger than 40 and peaks in the age group from 20 - 29 years ; a second peak is observed for women over 50 [ 2 , 3 ] . coexistence of sarcoidosis and breast cancer is reported in the literature , but there will always be a chance of misdiagnosis . we report a case of breast cancer presenting with a subcutaneous sarcoid lesion masquerading as a metastatic lesion . a 50-year - old female patient with type 2 diabetes who presented with cancer of the left breast ( stage t4a n1 m0 ) was treated with surgery ( left total mastectomy and axillary clearance ) , followed by radiotherapy to the chest wall ( to a dose of 50 gray in 25 fractions , 5 fractions / week ) and 6 cycles of chemotherapy ( fac ) followed by tamoxifen 20 mg once daily planned for the next 5 years . her histopathological details were infiltrating duct carcinoma grade 3 , 3 out of 5 axillary nodes had metastatic deposits with 1 node having perinodal spread . two years after surgery , the patient was on hormone therapy ( tamoxifen ) , and during this routine follow - up period , routine ultrasound of the abdomen and pelvis with gynecological checkup revealed an endocervical polyp in the uterine cervix which was treated with local excision and was histologically a leiomyomatous polyp . in the next follow - up month the patient presented with sudden onset ( 1 week ) of a painless swelling in the glabellar region of the forehead . she had a diffuse 4  4 cm , subcutaneous deposit . in view of the sudden onset and the patient being a known case of breast cancer with node positivity and perinodal spread , a clinical diagnosis of subcutaneous metastatic deposit clinically , the patient was locoregionally controlled for her breast cancer and other investigations for metastasis were made , such as chest x - ray , ultrasonogram of the abdomen and pelvis , and bone scan , which were also normal . local excision of the lesion revealed a grayish brown tissue of 2.5  1.5 cm , cut surface was grayish white with nodularity . microscopically , there were multiple discrete epithelioid cell granuloma with minimal lymphocytic response and small foci of necrosis . in some places the patient was treated with chloroquine for the next 6 months cq , 750 mg / day 11 . . they can present either at the same time or in sequence . both diseases can present with pulmonary nodules , which mimic metastasis or non - malignant disease in either of the cases leading to misdiagnosis . rarely , subcutaneous sarcoidosis occurs in patients without evidence of systemic disease [ 6 , 7 ] . although there have been many theories on the link between sarcoidosis and malignancy , the association remains unproven . most researchers believe that patients with pulmonary sarcoidosis are predisposed to develop malignancies , but others presume that malignancies lead to sarcoidosis . some authors even hypothesize that malignancy gives rise to sarcoidosis . the cause of a high risk of malignant neoplasms in patients with pulmonary sarcoidosis remains obscure . sarcoidosis patients develop breast cancer at an expected frequency , although the literature suggests an increased incidence of testicular cancers and lymphomas in patients with systemic sarcoidosis . chen et al .   reported 3 cases of breast cancer with coexistent pulmonary nodules which on biopsy revealed pulmonary sarcoidosis . tolaney et al .   also had the same clinical situation with pulmonary nodules in advanced breast cancer which proved to be sarcoid lesions on tissue biopsy . an unfortunate consequence of the presence of both entities in the same patient is the risk of misdiagnosis and incorrect treatment . to avoid such mishaps there are case reports on subcutaneous sarcoidosis mimicking metastatic breast cancer by mingins et al . , tolaney et al . , and gallimore et al . in our case we had high suspicion of a metastatic lesion , but in view of all other metastatic workup being negative , we performed an excision of the forehead lesion . this is probably the first case of subcutaneous sarcoidosis without systemic sarcoidosis in a breast cancer patient [ 6 , 8 , 10 , 11 ] . in conclusion , we have to keep in mind that there is a chance of the metastatic lesions being of sarcoidosis origin or other granulomatous disease .
subcutaneous sarcoidosis ( also known as  darier - roussy sarcoid ) is a cutaneous condition characterized by numerous deep - seated nodules on the trunk and extremities . 
 coexistence of sarcoidosis and breast cancer are reported in the literature , but there will always be a chance of misdiagnosis . 
 it is very crucial to obtain a tissue diagnosis of suspicious metastatic lesions . 
 we report a case of breast cancer presenting with a subcutaneous sarcoid lesion masquerading as a metastatic lesion . 
 a 50-year - old female patient , who had had cancer of the left breast , was on hormone therapy 2 years after treatment with surgery , radiotherapy and chemotherapy . 
 the patient presented with a sudden onset of a forehead subcutaneous swelling mimicking metastasis which on excision biopsy was proved to be sarcoidosis . in india , sarcoidosis is reported rarely . 
 we have to keep in mind that there is a chance of the metastatic lesions being of sarcoidosis origin or another granulomatous disease . to avoid misdiagnosis , 
 it is better to obtain a tissue diagnosis .