A 66-year-old man, who had been diagnosed with vasculitis 1 year previously, presented at our hospital with edema of the left leg and erythema of more than 1 year's duration (Fig. 1). He had been diagnosed with dermatitis and vasculitis in another hospital without being biopsied, and had been treated with topical steroids, oral antihistamines, antibacterials, hydrochlorothiazide, and Radix Salviae Miltiorrhizae, which provided some temporary benefit. He had no other complaints and denied any family history of breast cancer. No history of radiation therapy to the chest or hormone therapy was elicited. After biopsy of the skin lesion in our hospital, a breast mass was found, followed by lumpectomy for pathologic examination. The results of a physical examination showed a well-developed and well-nourished man. There was a 2-cm, palpable subareolar mass in the left breast with inguinal lymph node and axillary lymph node swelling; no discharge or tenderness was evident on breast mass palpation. The skin and nipple overlying the breast mass were normal. The right breast was unremarkable. Examination revealed solitary, nonpitting edema of the left thigh and buttock with erythema. Laboratory tests showed normal plasma α-L-fucosidase (AFU) and α-fetoprotein (AFP) and a carcinoembryonic antigen (CEA) level of 145.9 μg/L. Ultrasonography showed normal resonance in the prostate, bladder, liver, spleen, pancreas, and kidney, but abnormal resonance beside the aorta. Computed tomography (CT) showed lymph node swelling in the mediastina. The skin biopsy from the erythema of the left thigh revealed metastatic carcinoma (atypical cells in the lymphatic vessel). Pathologic examination of the breast mass revealed intraductal carcinoma (Figs 2 and 3). The breast mass was positive for presenilin-2 (PS2), c-erbB-2, and cytokeratin (CK), but negative for estrogen receptor (ER) and progesterone receptor (PR). The cutaneous metastasis was positive for CK but negative for PR, ER, PS2, and c-erbB-2. © 2007 The International Society of Dermatology.
