Skin changes are common breast symptoms. Suspicious changes described below should be referred as a USC.
The majority of breast skin issues are innocent and most can be managed without referral to secondary care.
USC Referral should be made for:
- Skin tethering
- Peau d’orange
- Unexplained, new breast ulceration
- Unilateral nipple eczema that is unresponsive to a two-week treatment with moderately potent topical steroid*
* In the experience of EBU Paget’s starts on the tip of the nipple and spreads out. Changes that are limited to the areola only are unlikely to be Paget’s.
(Details of other indications for Breast USC referral can be found under pages for Nipple symptoms, Breast Lumps, Breast Axillary Symptoms and Breast Abscess)
TF, EC, LP & JB FEB 26
Who to refer
Urgent Suspicion of Cancer Referral
- Skin tethering
- Peau d’orange
- Unexplained, new breast ulceration
- Unilateral nipple eczema that is unresponsive to a two-week treatment with moderately potent topical steroid*
* In the experience of EBU Paget’s starts on the tip of the nipple and spreads out. Changes that are limited to the areola only are unlikely to be Paget’s.
Routine Referral
- Persistent troublesome skin cysts may be referred to secondary care for consideration of elective excision.
Skin Cancer
- Skin cancer can affect the breast and suspected cases can be referred through dermatology pathways
How to refer
Edinburgh, Midlothian, and East Lothian Patients
- Please refer via SCI Gateway to WGH
Western General Hospital >> General Surgery – Breast >> LI Breast – Urgent
West Lothian Patients
- Please refer via SCI Gateway to SJH
St John’s Hospital >> General Surgery – Breast >> LI Breast – Urgent
Guidance on managing other Breast Skin Changes is summarised in the MPPP linked to below.
The same information is available on the RDS:
- Modernising Patient Pathways Programme: Breast Skin Problems
- Breast Skin Problems on RDS
- HRT: further information on the known increased risk of BC with HRT and its persistence after stopping MHRA
- Breast Cancer at MacMillan
- Breast Cancer at Cancer Research UK
- Breast Cancer at Breast Cancer Now
- Breast Cancer section of Scottish Referral Guidelines for Suspected Cancer on RDS
