cutaneous metastasis from primary internal malignancies is an uncommon presentation , with an incidence ranging from 0.7 to 10.4% , representing only 2% of all skin malignancies . the incidence of breast carcinoma cutaneous metastasis ( bccm ) has been reported as 23.9% in the largest series in the literature , therefore , making it the most common metastases in women seen by dermatologists . metastatic nodules are the most common followed by alopecia neoplastica , telangiectatic carcinoma and carcinoma erysipeloides . the majority of metastases are reported on the chest wall and other less common sites include the scalp , neck , upper extremities , and back . we report the case of a 75-year - old woman presenting to her gp with a 5  3 cm erythematous , flat , cutaneous lesion on her anterior right leg [ figure 1 ] . this cutaneous lesion had previously been diagnosed as dermatitis without biopsy 9 years ago and been managed with topical corticosteroid preparations . initially , this course of treatment had provided some temporary benefit . however , over the last year the lesion had become refractory to this treatment and had been slowly enlarging as well as becoming painful and itchy . examination revealed a 5  3 cm erythematous , flat skin lesion on the pretibial region of the right leg in this patient 's past medical record , there was a history of a right - sided lobular breast carcinoma with axillary lymph nodal spread that had been managed with surgery , radiotherapy , chemotherapy , and hormonal treatment 10 years prior to this presentation . additionally , she suffered from type ii diabetes mellitus , atrial fibrillation , and had had two previous cerebrovascular events . after referral to a dermatologist , punch biopsy revealed an infiltrate of malignant cells consistent with spread from an infiltrating lobular carcinoma of the breast [ figure 2 ] . further analysis demonstrated that the metastasis contained over 80% estrogen receptor positive cells [ figure 3 ] . as a result , the patient was commenced on endocrine treatment in the form of exemestane , an aromatase inhibitor . computed tomography scan of the thorax , abdomen , and pelvis revealed no other metastasis . on follow - up , 6 months after the diagnosis , the lesion was found to be static and the patient 's symptoms had resolved . the patient is currently being monitored in outpatient clinic . skin biopsy showed an infiltrate of malignant cells characterized by pleomorphic atypical nuclei and ample pale cytoplasm ( hematoxylin and eosin , 2000 ) carcinoma cells in skin biopsy stain positive for estrogen receptors ( immunohistochemistry for estrogen receptors ,  1000 ) cutaneous metastases are more commonly seen in breast cancer than in any other visceral malignancy in women . patients can present with cutaneous manifestations of breast disease at the time of their initial diagnosis or on occasion , well after diagnosis and management has been completed . additionally , these lesions have variable clinical appearances and can be mistaken for benign skin lesions . the patient in our case presented with a flat , erythematous lesion on her right leg that was misdiagnosed on clinical examination as dermatitis and managed intermittently with topical corticosteroids for 9 years . bccm commonly presents as a nodular lesion and dermatitis - like appearance is a rare presentation with only two previous cases reported in the literature . a presentation of bccm that is similar to our case is carcinoma erysipeloides , which is also known as inflammatory breast carcinoma . carcinoma erysipeloides is an uncommon form of cutaneous metastasis that is characterized by warm , tender , well - demarcated plaques that can resemble erysipelas or cellulitis and therefore can be misdiagnosed and incorrectly treated with antibiotics . the site of bccm in our case on the right leg was exceptionally distant to the location of the primary malignancy in the right breast . bccm usually presents in the chest wall in close proximity to the primary malignancy usually through direct extension or lymphatic spread and less commonly hematogenous spread . the metastatic pathway in our case was likely to be due to lymphatic spread as the patient had previous axillary lymph node involvement . although there are reports of bccm in the scalp , neck , back , abdomen , and upper extremities ; there are few cases in the literature of lower limb bccm . the remote location of cutaneous lesion in our case may have led clinicians to assume that it was unrelated to the patient 's history of breast cancer . this unusual case of remote cutaneous breast cancer metastasis that was misdiagnosed for nearly a decade as dermatitis highlights the variable clinical appearance of bccm . medical practitioners should be vigilant of the possibility of metastatic disease in breast cancer patients presenting as cutaneous lesions mimicking benign dermatological conditions . if there is any uncertainty regarding the etiology of cutaneous lesion , histological confirmation of diagnosis from tissue biopsy must be carried out . furthermore , it is important to acknowledge that bccm may be the first sign of undiagnosed breast cancer and further assessment by breast cancer specialists through triple assessment : clinical breast examination , mammography or ultrasound , and tissue biopsy of breast mass will be necessary . medical practitioners should be vigilant of the possibility of metastatic disease in breast cancer patients presenting as cutaneous lesions at sites remote to the breast that bear a resemblance to benign dermatological conditions .
cutaneous metastases from primary internal malignancies are an uncommon presentation . 
 cutaneous metastases are more frequently seen in breast cancer than in any other visceral malignancy in women . 
 medical practitioners should be vigilant of the possibility of unusual presentations of metastatic disease in breast cancer patients with lobular carcinoma presenting as cutaneous lesions mimicking benign dermatological conditions . 
 herein , we present a case of a 75-year - old woman presenting with cutaneous lobular breast carcinoma metastases on her anterior right leg , which had previously been misdiagnosed as dermatitis for 9 years .