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This photograph was taken by the plastic surgeon as part of routine pre-surgical planning for breast reconstruction. The diagnostic core needle biopsy skin entrance site is visible in the lower inner quadrant of the right breast (arrow). The site is located away from the patient's nipple, which is normal in appearance, and no other skin lesions are present. It was fortuitous that the photograph was taken shortly after the core needle biopsy before the skin puncture site had healed.
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The needle entered the breast at approximately 5:00 (Fig. 1). Photographs taken by her plastic surgeon prior to her mastectomy and reconstruction fortuitously showed the skin puncture site of the original core needle biopsy (Fig. 1).
One and a half years after mastectomy, the patient developed an erythematous skin lesion. Over the next several months, this lesion continued to increase in size (arrow). The nipple has been reconstructed.
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One and a half years after the mastectomy, the patient noted an area of skin change in the lower inner aspect of the right reconstructed breast (Fig. 2).
Three years after mastectomy, the lesion had increased to a size of 2 cm and now appeared eroded (arrow). It was noted at this time that the lesion was present at the site of the prior core needle biopsy based on the clinical photograph in Fig. 1. A skin punch biopsy was performed.
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The erythematous lesion now measured 2.5 x 2.0 cm and appeared eroded (Fig. 3).
The skin punch biopsy and subsequent complete skin excision revealed tumor cells involving the epidermis. No invasion of the dermis was seen. There was no evidence of an ectopic nipple, apocrine glands, or eccrine gland involvement.
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The carcinoma was restricted to the epidermis over a 1.7 cm area (Fig. 4).