Ipsilateral breast local recurrence in breast-conserving therapy observed in skin after 25 years – A case report

ABSTRACT

In this case report, we present a unique and compelling scenario of scar recurrence in a patient who underwent surgical resection for breast cancer a quarter-century ago. A 76-year-old woman was diagnosed with Stage III carcinoma in her right breast at the age of 50. She underwent breast conservation surgery with axillary clearance in 1996, followed by adjuvant treatment. After 25 years, she developed a nodule in her right breast over the previous surgical scar, which later ulcerated. Upon examination, a 3 × 3 cm ulcero-infiltrative lesion was found over the old surgical scar, fixed to the deep fascia (cT4bN0M0). She underwent a right simple mastectomy with part of the pectoralis major muscle. The histopathology report revealed ductal invasive breast carcinoma TNM (pT4bNxMx), triple positive luminal B-like with a Ki index of 10%, and CK5/6 negative in tumor islands. She was initiated on chemotherapy and aromatase inhibitors as adjuvant treatment. From this case report, we address the question of whether follow-up for breast cancer survivors should be extended throughout their lifetime using clinical and imaging techniques, or if the risk of recurrence is low enough to wait for it to occur without annual follow-up. Another question raised is the age at which follow-up for breast cancer survivors should cease, as current guidelines suggest diminishing benefits after the age of 70.