Atlas of breast cancer early detection

Thickening, retraction, or ulceration of the breast skin may be seen on ultrasound. The breast skin is sharply and uniformly defined. Normal breast skin thickness is 0.5–2 mm, as discussed earlier.

Skin thickening
Breast skin thickness > 2 mm on ultrasound may be seen as a result of a malignant mass with skin infiltration, acute mastitis or granulomatous mastitis, or postoperative changes.

Malignant mass with skin infiltration

Acute mastitis/granulomatous mastitis

Skin retraction
Skin retraction is seen in malignant masses with involvement of the supporting structures, the ligaments of Cooper, or extension of the breast malignancy into the skin. Surgical scarring or radiotherapy with fibrosis can lead to skin retraction as it heals with underlying fibrosis. Breast abscesses or burns heal with fibrosis and retracted skin. Detailed consideration of clinical presentation and associated findings is important to narrow the diagnosis of breast-retracted skin.

Skin ulceration
Skin ulceration may be seen in:

• infection and abscess formation with a breach in the overlying skin ;
• dermatological diseases;
• breast carcinoma ; or
• Paget disease with ulceration on the nipple–areolar complex .