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Skin Retraction
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Skin retraction: Skin abnormally pulled in, tethered, concave, dimpled
              • Skin invasion: Tumor extends into skin, usually directly overlying tumor
                • Skin retraction does not = skin invasion
                • Usually shows associated skin thickening
              • Peau d'orange = skin resembling peel of orange: Thickened, with prominent skin pores, often also erythematous
                • Implies lymphatic edema, usually seen with inflammatory carcinoma
              • Skin thickening: Thickness > 2 mm; can be focal or diffuse
                • Normal skin may be thicker in periareolar region, inframammary fold, parasternally

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Provencher L et al: Is clinical breast examination important for breast cancer detection? Curr Oncol. 23(4):e332-9, 2016
                                    2. Pereira O et al: Treatment of skin depression with combined upward suture traction and percutaneous subcision. Plast Reconstr Surg Glob Open. 3(10):e534, 2015
                                    3. Morris EA et al: Breast Imaging Reporting and Data System: BI-RADS, Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                    4. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                    5. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                    6. Uematsu T: MRI findings of inflammatory breast cancer, locally advanced breast cancer, and acute mastitis: T2-weighted images can increase the specificity of inflammatory breast cancer. Breast Cancer. 19(4):289-94, 2012
                                    7. Edge SB et al: AJCC Cancer Staging Handbook. 7th ed. New York: Springer, 2011
                                    8. Günhan-Bilgen I et al: Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology. 223(3):829-38, 2002
                                    9. Padhani AR et al: Magnetic resonance imaging of induration in the irradiated breast. Radiother Oncol. 64(2):157-62, 2002
                                    10. Le Gal M et al: Mammographic features of 455 invasive lobular carcinomas. Radiology. 185(3):705-8, 1992
                                    11. Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Skin retraction: Skin abnormally pulled in, tethered, concave, dimpled
                                                • Skin invasion: Tumor extends into skin, usually directly overlying tumor
                                                  • Skin retraction does not = skin invasion
                                                  • Usually shows associated skin thickening
                                                • Peau d'orange = skin resembling peel of orange: Thickened, with prominent skin pores, often also erythematous
                                                  • Implies lymphatic edema, usually seen with inflammatory carcinoma
                                                • Skin thickening: Thickness > 2 mm; can be focal or diffuse
                                                  • Normal skin may be thicker in periareolar region, inframammary fold, parasternally

                                              IMAGING

                                              • General Features

                                                • Mammographic Findings

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Provencher L et al: Is clinical breast examination important for breast cancer detection? Curr Oncol. 23(4):e332-9, 2016
                                                                      2. Pereira O et al: Treatment of skin depression with combined upward suture traction and percutaneous subcision. Plast Reconstr Surg Glob Open. 3(10):e534, 2015
                                                                      3. Morris EA et al: Breast Imaging Reporting and Data System: BI-RADS, Magnetic Resonance Imaging. 2nd ed. Reston: American College of Radiology, 2013
                                                                      4. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                                      5. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography. 5th ed. Reston: American College of Radiology, 2013
                                                                      6. Uematsu T: MRI findings of inflammatory breast cancer, locally advanced breast cancer, and acute mastitis: T2-weighted images can increase the specificity of inflammatory breast cancer. Breast Cancer. 19(4):289-94, 2012
                                                                      7. Edge SB et al: AJCC Cancer Staging Handbook. 7th ed. New York: Springer, 2011
                                                                      8. Günhan-Bilgen I et al: Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology. 223(3):829-38, 2002
                                                                      9. Padhani AR et al: Magnetic resonance imaging of induration in the irradiated breast. Radiother Oncol. 64(2):157-62, 2002
                                                                      10. Le Gal M et al: Mammographic features of 455 invasive lobular carcinomas. Radiology. 185(3):705-8, 1992
                                                                      11. Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988