Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• Spread radially in all directions.
• May become adherent to deep fascia or skin.
• Skin involvement may cause dimpling or retraction.
• Dermal lymphatic involvement may cause localized lyphmedema, giving rise to peau d'orange change.
• If there is extensive dermal lymphatic involvement, acute swelling, redness and tenderness of the area may follow. This feature is referred to clinically as inflammatory carcinoma.
• Spread by both lymphatics and blood.
• One third of patients have nodal metastasis at time of diagnosis.
• Favored sites for distant metastasis: lung, bone, liver, adrenals, brain and meninges.
• Pleural, peritoneal or CSF involvement can be detected by cytologic exam of the respective fluids.