Diffuse bruising on left breast

A woman in her late 50s was referred to breast clinic with a two month history of rapidly progressing, diffuse purplish discoloration on the medial aspect of her left breast. Eight years earlier she had undergone left wide local excision and sentinel lymph node biopsy for a grade II, triple negative invasive ductal carcinoma. She also received adjuvant chemotherapy and breast radiotherapy.

On examination, the skin of the left breast showed multiple ill defined purplish discoloured lesions, which were fragile and bled intermittently (fig 1). The skin appeared inflamed and thickened and the skin changes and bruising extended laterally towards the patient’s back.