Intended for healthcare professionals

Endgames Case Review

Diffuse bruising on left breast

BMJ 2020; 371 doi: (Published 18 November 2020) Cite this as: BMJ 2020;371:m4179
  1. Ye Ru Chin, plastic surgery registrar,
  2. Robert Warner, consultant plastic and reconstructive surgeon
  1. Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
  1. Correspondence to: Y R Chin chinyr{at}

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.

Fig 1

Left breast skin changes and lesions


  • 1.What is the most likely diagnosis?

  • What are other potential complications from breast radiotherapy?

  • How would you manage this condition?


1. What is the most likely diagnosis?

Radiotherapy induced angiosarcoma of the left …

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