Dermatologists’ Role in Breast Cancer Awareness and Survivorship

October marks Breast Cancer Awareness Month, a time to emphasize prevention, early detection, and survivorship care. While oncologists lead treatment, dermatologists play a vital yet underrecognized role in comprehensive breast cancer care. Breast cancer frequently presents with cutaneous manifestations, whether from direct tumor involvement, treatment-related effects, or associated genetic syndromes.¹ From identifying genetic risk markers to managing treatment-related skin toxicities and addressing psychosocial concerns, dermatologists significantly impact patient outcomes and quality of life throughout the cancer journey.

Genetic Syndromes and Shared Risk Factors

Several genetic mutations link breast cancer and dermatologic conditions, creating opportunities for early detection in dermatology practices. BRCA2 mutations increase risk for both breast cancer and melanoma, whereas PTEN mutations cause Cowden syndrome, characterized by distinctive mucocutaneous lesions including trichilemmomas, oral papillomas, and acral keratoses.^2,3

Dermatologists may be the first to identify these sentinel skin findings. Recognizing atypical nevi patterns in BRCA2 carriers or the pathognomonic features of Cowden syndrome can prompt genetic counseling and enhanced cancer surveillance. Incorporating targeted questions about family cancer history during the evaluation of suspicious skin lesions can facilitate earlier breast cancer detection and prevention strategies.

Radiation-Induced Skin Changes

Radiation therapy, a cornerstone of breast cancer treatment, frequently causes both acute and chronic cutaneous complications.⁴ Understanding the timeline and management of these changes is essential:

Acute changes (weeks 1-6):

• Radiation dermatitis presenting as erythema, edema, and pruritus
• Potential progression to moist desquamation in skin folds

Chronic changes (months to years):

• Skin fibrosis causing induration and restricted mobility
• Telangiectasias developing 6 to 12 months post treatment
• Pigmentary alterations and chronic pruritus

Management strategies include prophylactic moisturizers, gentle cleansing routines, and topical corticosteroids for inflammatory phases. For chronic fibrosis, early intervention with physical therapy and consideration of pentoxifylline or vitamin E may improve outcomes. Telangiectasias respond well to pulsed dye laser treatment when cosmetically concerning.

Navigating Systemic Therapy–Related Skin Toxicities

Modern breast cancer treatments, although increasingly effective, carry distinct dermatologic adverse effect profiles that require proactive management^5,6:

HER2-targeted therapies (trastuzumab, pertuzumab):

• Papulopustular eruptions resembling acne
• Paronychia and nail changes
• Xerosis and eczematous dermatitis

CDK4/6 inhibitors (palbociclib, ribociclib):

• Nonscarring alopecia
• Hand-foot skin reaction
• Mucositis

Immune checkpoint inhibitors (pembrolizumab, atezolizumab):

• Lichenoid eruptions
• Vitiligo-like depigmentation
• Severe immune-related adverse events (Stevens-Johnson syndrome, bullous pemphigoid–like reactions)

Early recognition and treatment of these toxicities prevent unnecessary dose reductions or treatment discontinuation. Establishing collaborative relationships with oncology teams ensures optimal management while maintaining therapeutic efficacy.

Enhanced Melanoma Surveillance

Breast cancer survivors face elevated melanoma risk due to multiple factors, including genetic predisposition, treatment-related immunosuppression, and increased medical surveillance leading to detection bias.⁵ This risk necessitates enhanced skin cancer screening protocols, such as the following:

• Annual total body skin examinations with dermoscopy
• Baseline photography for patients with multiple nevi
• Patient education on monthly self-examinations
• Aggressive sun protection counseling

Consider more frequent screening (every 6 months) for high-risk patients, including those with BRCA mutations, extensive sun damage, or a personal history of skin cancer.

Addressing Psychosocial and Cosmetic Concerns

The visible effects of breast cancer treatment (ie, scarring, alopecia, and pigmentary changes) profoundly impact self-image and quality of life.⁷ Dermatologists can offer both medical and procedural interventions, including the following:

For surgical scars:

• Silicone sheets or gels for hypertrophic scars
• Intralesional corticosteroids for keloids
• Fractional laser resurfacing for textural improvement

For chemotherapy-induced alopecia:

• Scalp cooling systems during infusion (when appropriate)
• Minoxidil to accelerate regrowth
• Camouflage techniques and high-quality wig referrals

For pigmentary changes:

• Hydroquinone or tretinoin for hyperpigmentation
• Cosmetic camouflage for persistent discoloration
• Narrowband UV-B for hypopigmented patches

Insurance coverage varies significantly for these interventions. Documenting functional impairment and psychological distress can support coverage appeals.

Implementing Breast Cancer Awareness in Dermatology

Dermatology clinics can serve as important touchpoints for breast cancer education and screening. Consider implementing the following practice enhancements:

Clinical protocols:

• Include breast cancer history in new patient questionnaires
• Document chemotherapy and radiation history in treatment records
• Flag high-risk patients (BRCA carriers, Cowden syndrome) for enhanced surveillance
• Coordinate care timing with oncology follow-ups

Patient education:

• Display breast self-examination guides alongside skin cancer materials
• Train staff to recognize and refer concerning symptoms
• Provide resources on genetic counseling when appropriate

Collaborative care:

• Establish referral relationships with breast oncologists
• Participate in tumor boards when relevant
• Share pertinent findings with the oncology team

Looking Ahead

During Breast Cancer Awareness Month and beyond, dermatologists have unique opportunities to impact breast cancer outcomes. Our expertise in recognizing genetic syndromes, managing treatment-related skin toxicities, and addressing cosmetic concerns positions us as essential members of the multidisciplinary cancer care team.

By integrating breast cancer awareness into routine dermatologic practice, from genetic risk assessment to survivorship care, we can contribute to earlier detection, improved treatment tolerance, and enhanced quality of life for patients. Let’s commit to making comprehensive skin health assessment as routine as mammography screening for breast cancer survivors, bridging the gap between dermatology and oncology to deliver truly integrated cancer care.

Hossein Akbarialiabad, MD, MSc, HMBA, is a transitional year resident physician at Washington University/BJC in St. Louis, Missouri, and a former research fellow at the University of Utah. His research interests focus on clinical dermatology and digital health innovation.

References

1. De Giorgi V, Grazzini M, Alfaioli B, et al. Cutaneous manifestations of breast carcinoma. Dermatol Ther. 2010;23(6):581-589. doi:10.1111/j.1529-8019.2010.01365.x

2. Narod SA, Metcalfe K, Finch A, et al. The risk of skin cancer in women who carry BRCA1 or BRCA2 mutations. Hered Cancer Clin Pract. 2024;13;22(1):7. doi:10.1186/s13053-024-00277-5

3. Pilarski R. Cowden syndrome: a critical review of the clinical literature. J Genet Couns. 2009;18(1):13-27. doi:10.1007/s10897-008-9187-7

4. Harper JL, Franklin LE, Jenrette JM, Aguero EG. Skin toxicity during breast irradiation: pathophysiology and management. South Med J. 2004;97(10):989-993. doi:10.1097/01.SMJ.0000140866.97278.87

5. Goggins W, Gao W, Tsao H. Association between female breast cancer and cutaneous melanoma. Int J Cancer. 2004;111(5):792-794. doi:10.1002/ijc.20322

6. Kaul S, Kaffenberger BH, Choi JN, Kwatra SG. Cutaneous adverse reactions of anticancer agents. Dermatol Clin. 2019;37(4):555-568. doi:10.1016/j.det.2019.05.013

7. Hoffmann T, Corrêa-Fissmer M, Duarte CS, Nazário RF, Barranco ABS, Oliveira KWK. Prevalence of dermatological complaints in patients undergoing treatment for breast cancer. An Bras Dermatol. 2018;93(3):362-367. doi:10.1590/abd1806-4841.20186541