RESUMEN
Carcinoma en cuirasse (CeC) is an extremely rare form of cutaneous metastasis of breast cancer. Guidelines for diagnosis and treatment of CeC are limited due to the small number of reported cases. It can be difficult to distinguish CeC from benign etiologies on initial presentation, but CeC can be easily distinguished by histopathology. Treatment of CeC focuses on palliation with no consensus on therapy guidelines. Treatment modalities that have been explored include chemotherapy, radiotherapy (with or without local hyperthermia), and hormonal antagonists. Here we present a 62-year-old woman with recurrent triple-negative breast cancer manifesting as CeC to the chest wall.
RESUMEN
Clinicians have a tendency to dismiss patients with psychiatric illness like skin picking disorder without assessing completely for organic disease. Patients with psychocutaneous disease have the potential to develop true dermatopathology and should always be examined thoroughly. We describe a case of skin picking disorder with underlying pilomatricoma. The patient met criteria for skin picking disorder and had been prescribed numerous topical treatments without efficacy by countless physicians over 18 years. In addition, a pilomatricoma was discovered within a self-inflicted ulcer. Pilomatricomas can rarely result from trauma and develop ossification, both of which were true of this lesion. The prevalence of skin picking disorder proves more pervasive than previously realized and it has only recently been recognized by the DSM-5 as an independent diagnosis. Therefore, it is necessary to clarify the diagnosis as well as remind clinicians not to discount underlying dermatologic disease. In addition to the risk of bleeding and infection, these patients are at risk for masking neoplasms, which should be removed. Our case emphasizes the need for thorough examination of patients with psychocutaneous disease and further work-up when necessary to prevent permanent disfigurement.