The spectrum of vascular lesions in the mammary skin, including angiosarcoma, after breast conservation treatment for breast cancer

BACKGROUND: With the general acceptance of lumpectomy, axillary staging, an d radiotherapy as local treatment for infiltrating breast cancer, an apprec iation is evolving for the spectrum of vascular lesions that occur in the m ammary skin after this treatment. Most of these lesions develop within the prior radiation field after breast conservation treatment. STUDY DESIGN: A retrospective chart and slide review was conducted, consist ing of five patients with cutaneous vascular lesions after breast conservat ion treatment for infiltrating breast cancer. RESULTS: The latent rime interval from definitive treatment of breast cance r to the clinical recognition of vascular lesions ranged from 5 to 11 years . Two patients did not have either arm or breast edema, two patients had br east edema, and the fifth patient had arm edema. Lesions arising in the: ir radiated mammary skin included extensive lymphangiectasia (one), atypical v ascular lesions (two), and cutaneous angiosarcoma (four). CONCLUSIONS: Atypical vascular lesions at the skin margins of mastectomy ma y be predictive of recurrence after resection of angiosarcoma. Excision of skin from the entire radiation field may be necessary to secure local contr ol of the chest wall in patients with cutaneous angiosarcoma. after therape utic breast radiotherapy. (J Am Coll Surg 2001;133:22-28. (C) 2001 by the A merican College of Surgeons).