Breast Dimpling: Can This Be a Sign of Breast Cancer?

A multitude of conditions can cause changes to the skin on your breast, such as infections, heat rash, allergic reactions, eczema, psoriasis, or benign breast disease.

However, dimpling, puckering, or pitting that looks similar to an orange peel – sometimes called peau d’orange – is often a specific sign of breast cancer and should be seen by a doctor right away.

Sometimes rashes or dimpling with breast cancer can happen when a tumor is growing under your skin and pulls it inward, said Saranya Chumsri, MD, a hematologist-oncologist at the Mayo Clinic in Jacksonville, Florida.

Often, however, dimpling can be a sign of a rare but serious form of breast cancer called inflammatory breast cancer (IBC), she said. With IBC, rather than forming tumors that cause structural changes to your skin, cancer cells block the lymphatic channels in the skin of your breast – the small tubes where lymph fluid drains.

“The cancer has blocked the lymph from draining, which makes the skin look like an orange peel,” Dr. Chumsri explained. “This can present like inflammation or an infection of the breast but doesn’t get better with antibiotics.” This type of cancer is fast-growing, and most commonly a more aggressive subtype, Dr. Chumsri said – either triple-negative or HER2-positive.

IBC can cause sudden changes of appearance on one breast, occurring over a matter of weeks. In addition to dimpling, ridges, or pitting of the skin, symptoms of IBC include:

• Thick, heavy, or enlarged feeling in one breast

• Discoloration

• Unusual warmth

• Tender, painful, or achy breast

• Swollen lymph nodes under one arm or around the collarbone

• Flattening or inversion of the nipple

• Itchiness, unusual firmness, or thickening of skin

Because many of these signs can be easily mistaken for an infection or other benign skin changes, it’s important to see your doctor right away to rule out IBC.

Sometimes, an inflammatory reaction called fat necrosis can also cause skin changes in the breast that can be hard to distinguish from IBC. With fat necrosis, or death of the fatty tissue in your breast, scar tissue replaces damaged breast tissue. This healing process can cause irregular skin changes that vary widely and can sometimes include lumps, firm spots, nipple inversion, or dimpling.

However, fat necrosis looks subtly different from IBC, said Dr. Chumsri, and can often be traced to a specific event. “It’s usually more like thickened skin in an area where a patient had surgery, or some kind of trauma, or sometimes with radiation,” she explained. “Usually with imaging we can tell whether it’s fat necrosis or not, though it’s not 100%.”

If your skin dimpling is caused by a tumor, your doctor may catch it during a routine breast exam. For example, they may do a “pushing” test on your breast to see if pushing your breast tissue around causes the skin to pucker, indicating that a cancerous lump or mass has attached underneath the skin.

IBC doesn’t generally cause lumps to form, so it can be harder to catch. Because it can look very similar to mastitis, which is common, your doctor may first give you antibiotics to see if your symptoms go away. If these don’t work, they will likely take a biopsy of your skin to make sure there are no cancer cells present.

They may also do common imaging tests such as a mammogram, breast ultrasound, or breast MRI. Ultimately, however, a biopsy is the only way to confirm whether skin changes are caused by breast cancer.

The prognosis for breast cancer that causes skin dimpling is often poor, Dr. Chumsri said. If it’s caused by IBC, because this type is so aggressive, it’s almost always diagnosed at stage III or IV, she said. Even if skin dimpling is not caused by IBC, because the cancer has reached the skin, it’s already considered stage III.

However, IBC is not a death sentence, and prognosis depends on a person’s cancer subtype. For example, HER2-positive cancer is aggressive, but it has many targeted treatment options that can greatly improve a person’s outlook, Dr. Chumsri said.

For IBC, treatment usually begins with chemotherapy, and targeted therapy if it is HER2-positive. You may also be treated with surgery, chemotherapy, radiation, targeted treatment, hormone therapy, or various types of immunotherapy. These depend on your cancer subtype, whether it has spread to other parts of the body, and whether your cancer is inflammatory or not.