Cutaneous Metastasis of Breast Cancer: Mechanisms, Clinical Significance, and New Perspectives in Integrative Therapy
Comprehensive understanding of breast cancer skin metastasis, from pathological mechanisms to the latest clinical applications of integrated therapy
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Clinical Significance of Breast Cancer Skin Metastasis
Breast cancer is one of the most common cancers among women worldwide, and cutaneous metastasis indicates systemic disease dissemination. Epidemiological data suggest that approximately 20–25% of patients with advanced breast cancer will develop skin metastasis (Cleveland Clinic, 2025). Skin metastasis usually signifies disease progression, greater therapeutic difficulty, and substantial decline in quality of life.
Its clinical significance lies not only in prognosis but also in psychosocial dimensions. Patients often suffer anxiety and depression due to cosmetic changes, ulcerative lesions, discharge, and pain, further reducing treatment adherence (ASCO/SIO, 2025). Thus, management requires a holistic care perspective, balancing tumor control with quality-of-life improvement.
Mechanisms and Pathological Features
Breast cancer cells metastasize to the skin through three main pathways:
- Lymphatic spread: Tumor cells migrate along lymphatic channels, forming nodules or cellulitis-like lesions.
- Hematogenous spread: Dissemination via the bloodstream, often resulting in multiple nodules.
- Direct invasion: Extension from the primary tumor to adjacent skin, usually in locally advanced or recurrent cases (NCI, 2025).
Pathological presentations may include:
- Solitary or multiple subcutaneous nodules
- Erythematous plaques resembling dermatitis
- Sclerotic or peau d’orange–like changes, similar to inflammatory breast cancer
- Ulcerative lesions with exudation and infection risk (Osmosis, 2025)
Diagnostic Approach and Clinical Challenges
Diagnosis relies on clinical assessment, imaging, and biopsy:
- Careful inspection of breast and chest wall skin nodules.
- PET-CT and MRI help evaluate systemic spread.
- Biopsy remains the gold standard, with immunohistochemistry confirming primary origin.
Challenges include misdiagnosis, since cutaneous metastasis may mimic benign skin conditions (e.g., cellulitis or eczema), delaying treatment. For patients with rapidly progressing disease, timely diagnosis is critical.
Current Standard of Care and Limitations
Cutaneous metastasis signals late-stage breast cancer; therapy is primarily systemic, with local measures as adjuncts:
- Systemic therapy: Chemotherapy, endocrine therapy, targeted agents (e.g., HER2 inhibitors), immune checkpoint inhibitors.
- Local therapy: Radiotherapy, surgical excision for isolated lesions, cryotherapy, or electrotherapy.
- Supportive care: Analgesics, infection control, wound care (OncoDaily, 2025).
However, standard therapies largely focus on disease control, rarely achieving cure. Patients endure long-term side effects and compromised quality of life—underscoring the need for integrative oncology.
Role of Integrative Therapies
Nutritional and Immunonutrition Interventions
Cancer patients often experience malnutrition and cachexia, particularly in advanced stages. Immunonutrition (IN)formulas include:
- L-arginine: Enhances immune cell function
- Glutamine: Protects intestinal barrier, lowers infection risk
- Omega-3 fatty acids: Reduce inflammation
- Nucleotides: Support cellular repair
Clinical studies show that IN reduces postoperative infections, shortens hospital stay, and improves immune function (Arends et al., 2021). In breast cancer, peri-treatment IN supports immune response and reduces complications (Zhang et al., 2019).
Anti-Inflammatory Diet and Lifestyle
- Mediterranean diet: Rich in fruits, vegetables, whole grains, fish, olive oil—shown to lower chronic inflammation (De Cicco et al., 2021).
- Polyphenols: EGCG, curcumin, and berry-derived compounds with immunomodulatory and anti-cancer properties.
- Limiting processed foods and sugar: Reduces pro-inflammatory tumor microenvironment.
Mind-Body Medicine
- Psychological stress raises cortisol, weakening immunity.
- Mindfulness and yoga: Improve anxiety, sleep quality.
- Music and aromatherapy: Reduce fatigue and stress.
Clinical evidence supports these interventions for improved quality of life and immune modulation (Greenlee et al., 2017).
Natural and Complementary Therapies
- Curcumin: Anti-inflammatory and anti-cancer activity (Hsu et al., 2021).
- Vitamin D: Deficiency correlates with poor prognosis; supplementation supports immune function.
- Acupuncture: Systematic reviews confirm benefits in fatigue and therapy-related side effects (Lu et al., 2019).
Caution: Complementary therapies should be supervised by professionals to avoid interactions with chemotherapy or targeted drugs.
Multidisciplinary Care Model
Optimal strategy involves collaborative care:
- Oncologists: Disease control
- Dietitians: Personalized nutrition and IN
- Psychologists: Stress management and support
- Integrative medicine physicians: Supervision of complementary therapies
This model improves adherence, reduces adverse effects, and enhances quality of life (Deng et al., 2021).
Future Directions
With advances in immunotherapy and targeted agents, management is shifting toward tumor control + immune support + quality-of-life optimization. Future research should explore:
- Synergy between immunonutrition and immunotherapy
- Impact of personalized nutrition and gut microbiota on treatment response
- Psychosocial interventions’ link with immune outcomes
Conclusion
Although cutaneous metastasis indicates advanced breast cancer, combining standard treatments with integrative therapies can substantially improve outcomes and quality of life. A multilayered integrative model—spanning nutrition, lifestyle, psychosocial, and complementary medicine—represents the future of supportive care in late-stage breast cancer.
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References
- Arends, J., Bachmann, P., Baracos, V., et al. (2021). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 40(5), 2898–2913.
- Cleveland Clinic. (2025). Carcinomatosis: Definition and implications.
- De Cicco, P., Catani, M. V., Gasperi, V., Sibilano, M., Quaglietta, M., & Savini, I. (2021). Nutrition and breast cancer: A literature review on prevention, treatment and recurrence. Nutrients, 13(11), 3889.
- Deng, G., et al. (2021). Integrative oncology practice at academic cancer centers. CA: A Cancer Journal for Clinicians, 71(2), 120–138.
- Greenlee, H., Balneaves, L. G., Carlson, L. E., et al. (2017). Clinical practice guidelines on integrative therapies for breast cancer patients. Journal of Clinical Oncology, 35(18), 1962–1981.
- Hsu, C. H., et al. (2021). Natural compounds and cancer therapy: Risks and benefits. Frontiers in Pharmacology, 12, 665999.
- Lu, W., et al. (2019). Acupuncture for cancer-related symptoms. Cochrane Database of Systematic Reviews.
- National Cancer Institute. (2025). Definition: Carcinomatosis. NCI Dictionary of Cancer Terms.
- OncoDaily. (2025). Carcinomatosis: Treatment challenges in oncology.
- Osmosis. (2025). Carcinomatosis: Clinical overview and diagnosis.
- Zhang, X., Liang, X., Yan, Y., et al. (2019). The role of perioperative immunonutrition in breast cancer patients. Clinical Nutrition, 38(1), 260–266.