Synopsis
Recognise the rapid diffuse clinical phenotype of inflammatory breast cancer, secure representative tissue and staging promptly, and apply the neoadjuvant systemic–local treatment sequence.
- Inflammatory breast cancer is an aggressive clinical presentation of invasive carcinoma causing rapid diffuse breast erythema, oedema and enlargement through dermal lymphatic obstruction.
- A discrete mass may be absent. Peau d’orange, warmth, heaviness, tenderness, nipple flattening and regional nodes can resemble mastitis, cellulitis or an abscess.
- Ask about lactation, fever, systemic toxicity, symptom speed and antibiotic response, but do not require infection to be excluded for weeks before arranging cancer assessment.
Key red flags
Rapid diffuse breast enlargement, erythema, warmth, peau d’orange, nipple retraction or bulky nodes without a drainable collection, especially when antibiotics fail, requires urgent breast imaging and core biopsy.
Investigation priorities
Find a representative breast target, assess diffuse structural change and guide core biopsy.
Management branches
A non-lactating 49-year-old has three weeks of diffuse erythema and peau d’orange, no drainable collection and no improvement after appropriate antibiotics.
- Assess observations and sepsis immediately, record the area and tempo of skin change, examine both breasts and all regional nodal basins.
- Arrange urgent diagnostic mammography, breast and axillary ultrasound, targeting any mass, distortion or abnormal node for tissue.