pyoderma gangrenosum

[Mandelin Rain]

Seeing a breast cancer patient who developed PG on her breast during neoadjuvant chemotherapy. She was placed on prednisone with slow improvement. She has yet to have definitive surgery. Now, they are wondering if it's a contraindication to XRT for surgical planning.

Not much out there. Couple case reports of this occurring after surgery/radiation. Single case series of using XRT for recalcitrant pyoderma gangrenosum. She is "unsuitable" for APBI. I worry about how they'd be able to close a mastectomy with this skin issue. I think cosmesis will likely be poor not matter what.

Anyone ever come across this? If so, what did you do?

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[evilbooyaa]

Never heard of this being a contraindication to radiation? What happens if you treat through it?

 

[Mandelin Rain]

Never heard of this being a contraindication to radiation? What happens if you treat through it?

No idea. It's a sterile infiltration of neutrophils causing local skin necrosis. I think it could do any of get better by killing the neutrophils, get worse by the inflammation recruiting more neutrophils, or not change.

The ulceration is actually distant on the breast (in the mid-lateral IM fold) from the tumor (upper-inner quadrant). She had initial tumor size 2.5 cm, HER2+ that is no longer palpable after neoadjuvant tx. Thinking maybe of doing external bean APBI to stay off the ulcerated skin, though she is outside the consensus statement guidelines. Otherwise, just observe and accept a higher recurrence rate. Not sure. It's a new one for me.