Peau d'orange

Usually a late sign of breast cancer, peau d'orange (orange peel skin) is the edematous thickening and pitting of breast skin. This slowly developing sign can also occur with breast or axillary lymph node infection, erysipelas, or Graves'disease. Its striking orange peel appearance stems from lymphatic edema around deepened hair follicles. (See Recognizing peau d'orange.)

History and physical examination

Ask the patient when she first detected peau d'orange. Has she noticed lumps, pain, or other breast changes? Does she have related signs and symptoms, such as fever, malaise, achiness, and weight loss? Is she lactating, or has she recently weaned her infant? Has she noticed any nipple discharge? Has she had previous axillary surgery that might have impaired lymphatic drainage of a breast?

In a well-lit examining room, observe the patient's breasts. Estimate the extent of the peau d'orange and check for erythema. Assess the nipples for discharge, deviation, retraction, dimpling, and cracking. Gently palpate the area of peau d'orange, noting warmth or induration. Then palpate the entire breast, noting fixed or mobile lumps, and the axillary lymph nodes, noting enlargement. Finally, take the patient's temperature.

Medical causes

Breast abscess.Breast abscess causes peau d'orange, malaise, breast tenderness and erythema, and a sudden fever that may be accompanied by shaking chills. A cracked nipple may produce a purulent discharge, and an indurated or palpable soft mass may be present.

Breast cancer.Advanced breast cancer is the most likely cause of peau d'orange, which usually begins in the dependent part of the breast or the areola. Palpation typically reveals a firm, immobile mass that adheres to the skin above the area of peau d'orange. Inspection of the breasts may reveal changes in contour, size, or symmetry. Inspection of the nipples may reveal deviation, erosion, retraction, and a thin and watery, bloody, or purulent discharge. The patient may report a burning and itching sensation in the nipples as well as a sensation of warmth or heat in the breast. Breast pain may occur, but it isn't a reliable indicator of cancer.

Nursing considerations

▪ Because peau d'orange usually signals advanced breast cancer, provide emotional support for the patient.

▪ Encourage her to express her fears and concerns.

▪ Prepare the patient for biopsy, surgery, chemotherapy, or radiation therapy.

Patient teaching

▪ Explain the underlying cause and treatment plan.

▪ Explain expected diagnostic tests, such as mammography and breast biopsy.

▪ Teach the patient how to perform monthly breast self-examinations.

▪ Discuss signs and symptoms the patient should report.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Breast symptoms: Introduction (review 210 causes)
• Next Book Extract About Breast symptoms: Breast nodule [Breast lump] (Nursing: Interpreting Signs and Symptoms)
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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

 » Next page: Breast nodule [Breast lump] (Nursing: Interpreting Signs and Symptoms)

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