{"id":3750,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastskinchanges\/"},"modified":"2026-02-11T09:01:10","modified_gmt":"2026-02-11T09:01:10","slug":"breastskinchanges","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastskinchanges\/","title":{"rendered":"Breast Skin Changes"},"content":{"rendered":"\n<p>Skin changes are common breast symptoms. Suspicious changes described below should be referred as a USC.<\/p>\n\n\n\n<p>The majority of breast skin issues are innocent and most can be managed without referral to secondary care.<\/p>\n\n\n\n<p><strong><u>USC Referral should be made for:<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin tethering<\/li>\n\n\n\n<li>Peau d\u2019orange<\/li>\n\n\n\n<li>Unexplained, new breast ulceration<\/li>\n\n\n\n<li>Unilateral nipple eczema that is unresponsive to a two-week treatment with moderately potent topical steroid*<\/li>\n<\/ul>\n\n\n\n<p>* In the experience of EBU Paget\u2019s starts on the tip of the nipple and spreads out. Changes that are limited to the areola only are unlikely to be Paget\u2019s.<\/p>\n\n\n\n<p>(Details of other indications for Breast USC referral can be found under pages for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/nipplesymptoms\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/nipplesymptoms\/\" target=\"_blank\" rel=\"noreferrer noopener\">Nipple symptoms<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastlump\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastlump\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Lumps<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/axillary-symptoms\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/axillary-symptoms\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Axillary Symptoms<\/a> and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastabscess\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastabscess\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Abscess<\/a>) <\/p>\n\n\n\n<p>The <a href=\"https:\/\/nhscfsd.co.uk\/media\/tgwfh2sj\/nhs-scotland-breast-skin-problems-pathway-v1-october-2023.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Modernising Patient Pathways Programme summarises best practice for managing other Breast Skin Problems<\/a>.<\/p>\n\n\n\n<p><strong>TF, EC, LP &amp; JB FEB 26<\/strong>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Urgent Suspicion of Cancer Referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin tethering<\/li>\n\n\n\n<li>Peau d\u2019orange<\/li>\n\n\n\n<li>Unexplained, new breast ulceration<\/li>\n\n\n\n<li>Unilateral nipple eczema that is unresponsive to a two-week treatment with moderately potent topical steroid*<\/li>\n<\/ul>\n\n\n\n<p>* In the experience of EBU Paget\u2019s starts on the tip of the nipple and spreads out. Changes that are limited to the areola only are unlikely to be Paget\u2019s.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Routine Referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Persistent troublesome skin cysts may be referred to secondary care for consideration of elective excision.<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Skin Cancer<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin cancer can affect the breast and suspected cases can be referred through dermatology pathways<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer<\/h4>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Edinburgh, Midlothian, and East Lothian Patients<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please refer via SCI Gateway to WGH<\/li>\n<\/ul>\n\n\n\n<p>Western General Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Urgent<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>West Lothian Patients<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please refer via SCI Gateway to SJH<\/li>\n<\/ul>\n\n\n\n<p>St John\u2019s Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Urgent<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Guidance on managing other Breast Skin Changes is summarised in the MPPP linked to below.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/nhscfsd.co.uk\/media\/tgwfh2sj\/nhs-scotland-breast-skin-problems-pathway-v1-october-2023.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Modernising Patient Pathways Programme: Breast Skin Problems<\/a><\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>The same information is available on the RDS:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/breast-pathways\/breast-skin-problems\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Skin Problems on RDS<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/nhscfsd.co.uk\/media\/tgwfh2sj\/nhs-scotland-breast-skin-problems-pathway-v1-october-2023.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Modernising Patient Pathways Programme: Breast Skin Problems<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/breast-pathways\/breast-skin-problems\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Skin Problems on RDS<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Sexual-Health-HRT-Further-Info-Incr-Risk-Breast-Ca-MHRADDL_HRT_30.08.19.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">HRT: further information on the known increased risk of BC with HRT and its persistence after stopping MHRA<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.macmillan.org.uk\/cancer-information-and-support\/breast-cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at MacMillan<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/breast-cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at Cancer Research UK<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/breastcancernow.org\/#main-content\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at Breast Cancer Now<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/breast-cancer\/?searchTerm=scottish%20referral%20guidelines%20for%20suspected%20cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer section of Scottish Referral Guidelines for Suspected Cancer on RDS<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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: * In the experience of EBU Paget&rsquo;s starts on the tip of the nipple and<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3744,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[55],"class_list":["post-3750","page","type-page","status-publish","hentry","category-breastskinchanges"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/breastdisease\/breastskinchanges\/\" rel=\"tag\">Breast Skin Changes<\/a>","rttpg_excerpt":"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: * In the experience of EBU Paget&rsquo;s starts on the tip of the nipple and","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3750","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3750"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3750\/revisions"}],"predecessor-version":[{"id":26747,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3750\/revisions\/26747"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3744"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3750"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3750"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}