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Old 01-31-2014, 10:11 AM   #1
Shobha
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worried: bumps on scar line - biopsy indicates allergy

Hi All,

Was wondering if anyone else had essentially benign bumps on the scar line.

This has been worrying me for a while. It started about a year ago, on the mastectomy scar on the right side (cancer had been on the left). The bumps were itchy and red. I had panicked and had shave biopsy done and the result was a "Spongiotic dermatitis with dermal eosinophils" and not cancer. I was very relieved and applied the prescribed cortisone cream. The bumps go away with the cream but come back every now and then.

The problem is that it has been an year and this condition keeps coming back and I am worried that I may be ignoring the underlying problem. Just want to be sure this is not cancer.

Any insights or if has anyone else experienced this issue?

Thanks,
shobha
__________________
DX: 06-30-2007 - left breast -stage IIIB, Her2/Neu 3+++, ER weakly positive, PR-
Taxol+herceptin weekly for 3 months
FEC+herceptin every 3 weeks for 3 months
BRCA 1 and 2 - Negative
Jan 2008 - Bilateral mastectomy, prophylactic Rt. side.
Radiation for 5 weeks
Completed my yr of herceptin on 07-14-2008
Brain MRI - 3/2/09 Clean
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Old 01-31-2014, 12:22 PM   #2
Becky
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Re: worried: bumps on scar line - biopsy indicates allergy

I had/have numerous issues with the skin on my breast. Spider veins formed in 2 areas (caused by radiation) but I watch it and actually measured it and took pictures to make sure it does not change. Everyone says its radiation damage but we don't trust anyone anymore - do we? I also have a dermatitis rash especially when I'm sweaty so its more a summer thing. I have to really let myself dry well. It gets itchy too but it is such a large area, I don't want to put cortisone cream on it all the time because the areas are so big. The cream makes it go away quickly though.

Skin mets won't go away with cortisone cream. That I am pretty sure of. Just like they won't go away with antibiotics and other "normal" drugs. Test it with the cream. Does it still go away? Are you taking a daily allergy pill like Zyrtec or Claratin? That may help alot. However, don't ignore anything new or anything that doesn't go away. I just got diagnosed with a small basal cell carcinoma on my face yesterday (biopsied) and I though it was just a pimple that wouldn't go away (very small). I am getting Moh's micrographic surgery on it a week from today. I was shocked but basal cell is a very benign cancer and doesn't spread. I almost felt silly to have it checked. Good thing I did because they can grow but never become invasive but the removal and potential scarring is worse the bigger they get. Never feel silly because you never know. If you continue to worry about this, get another scrape biopsy to alleviate your worries.
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Old 01-31-2014, 12:58 PM   #3
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Re: worried: bumps on scar line - biopsy indicates allergy

This link from the National Library of Medicine/National Institute of Health has detailed info: http://www.nlm.nih.gov/medlineplus/e...cle/003649.htm
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Old 01-31-2014, 01:48 PM   #4
Shobha
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Re: worried: bumps on scar line - biopsy indicates allergy

Thanks Becky. You read my feelings perfectly - I just want to be super sure. My bumps do go away with the cortisone cream, so I am relieved to know it cannot be mets. I have not taken claritin or other oral anti-allergy medication. Will definitely try it.

So glad that you were vigilant and caught the small basal cell carcinoma quickly. Wishing you an easy and quick recovery from the surgery.

hugs,
shobha
__________________
DX: 06-30-2007 - left breast -stage IIIB, Her2/Neu 3+++, ER weakly positive, PR-
Taxol+herceptin weekly for 3 months
FEC+herceptin every 3 weeks for 3 months
BRCA 1 and 2 - Negative
Jan 2008 - Bilateral mastectomy, prophylactic Rt. side.
Radiation for 5 weeks
Completed my yr of herceptin on 07-14-2008
Brain MRI - 3/2/09 Clean
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Old 01-31-2014, 01:51 PM   #5
Shobha
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Re: worried: bumps on scar line - biopsy indicates allergy

Thanks Jackie - I read all the information on the link provided regarding eosinophils - seems like some medications can increase their presence and cause skin problems. I will have to check my supplements, just in case.

hugs,
shobha
__________________
DX: 06-30-2007 - left breast -stage IIIB, Her2/Neu 3+++, ER weakly positive, PR-
Taxol+herceptin weekly for 3 months
FEC+herceptin every 3 weeks for 3 months
BRCA 1 and 2 - Negative
Jan 2008 - Bilateral mastectomy, prophylactic Rt. side.
Radiation for 5 weeks
Completed my yr of herceptin on 07-14-2008
Brain MRI - 3/2/09 Clean
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Old 02-03-2014, 04:21 AM   #6
Aussie Girl
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Re: worried: bumps on scar line - biopsy indicates allergy

Dear Shobha,

I'm a pathologist and I see this kind of skin reaction every day under my microscope. IT IS NOT CANCER!

About 50% of the time no specific cause is found, but it can be due to a drug, or food, insect bite, a cream applied to the skin, laundry powder etc. Occasionally a fungal infection is the cause, but that would have probably shown on the biopsy, if no anti-fungal cream had been used prior to the biopsy. Some people just have a tendency to rashes (eczema).

Mostly the treatment is corticosteroid cream which an oral antihistamine if particularly itchy.

Hope it clears up soon.

Aussie Girl
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31mm Infiltrating duct carcinoma
Grade 3, ER/PR-, HER2+, Neg Sentinel nodes x 5
49mm field of DCIS
17 June '13: Screen detected impalpable mass, Mammogram neg, US.
25 June '13: Diagnosed after multiple biopsies and MRIs
28 June '13: Left lumpectomey
4 July '13: Left Mastectomy
12 August '13: Commenced TCH chemo
Mid December '13 : TCH finished. Herceptin continuing three weekly.
4 August 2014- Herceptin infusions finished.
END OF THERAPY - YAY!
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Old 02-03-2014, 10:42 AM   #7
AlaskaAngel
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Angry Re: worried: bumps on scar line - biopsy indicates allergy

Because my older sister also had IDC bc 2 years before my dx, and then about 12 years later developed IBC (but had no recurrence of IDC), I have always been watchful too for any bumps or rashes.

I broke out with an itchy rash, mostly under the breasts, some time ago, and so I saw my PCP for that. He said my skin was becoming more dry, and recommended a hospital-used lotion for dry skin plus tepid baths taken less often. The rash persisted, and spread all over me. Eventually I traveled to the Lower 48 where I could see a derm doc. The derm doc provided the steroid creams that helped reduce the rash but it never went away and it got worse when I stopped using the creams, so the derm doc biopsied me in several places. The bx showed nothing specific.

The rash is very uncomfortable, and at present is only relieved with the constant application of baby oil that includes aloe and vitamin E.

I saw another PCP, who put me on the waiting list for a second derm opinion (and left me there with no further treatment, saying that it can take months to get in to see one).

I remain in limbo at present, waiting to get that second opinion, very uncomfortable and very annoyed. It isn't IBC, thank goodness, but it is still very difficult to cope with.
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Dx 2002 age 51
bc for granny, aunt, cousin, sister, mother.
ER+/PR+/HER2+++, grade 3
IDC 1.9 cm, some DCIS, Stage 1, Grade 3
Lumpectomy, CAFx6 (no blood boosters), IMRT rads, 1 3/4 yr tamoxifen
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Old 02-03-2014, 12:09 PM   #8
Shobha
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Re: worried: bumps on scar line - biopsy indicates allergy

Thanks Aussie Girl! It does go away quickly with the prescribed cream and I probably have to learn to live with it. I am watching closely for the triggers that make these bumps appear.

AlaskaAngel - I am trying to slowly accept that this may continue but like you said it is difficult to cope since we are always dreading the worst. Wishing you the best - I don't understand what it is about the Dermatologists - very difficult to get an appointment within a month!

hugs,
shobha
__________________
DX: 06-30-2007 - left breast -stage IIIB, Her2/Neu 3+++, ER weakly positive, PR-
Taxol+herceptin weekly for 3 months
FEC+herceptin every 3 weeks for 3 months
BRCA 1 and 2 - Negative
Jan 2008 - Bilateral mastectomy, prophylactic Rt. side.
Radiation for 5 weeks
Completed my yr of herceptin on 07-14-2008
Brain MRI - 3/2/09 Clean
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Old 02-03-2014, 12:33 PM   #9
AlaskaAngel
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Re: worried: bumps on scar line - biopsy indicates allergy

Hugs to you too, shobha, and may you find relief from it! I have agreed to see the derm doc's NP soon, and will pass on what results come of that, if any.

A.A.
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Dx 2002 age 51
bc for granny, aunt, cousin, sister, mother.
ER+/PR+/HER2+++, grade 3
IDC 1.9 cm, some DCIS, Stage 1, Grade 3
Lumpectomy, CAFx6 (no blood boosters), IMRT rads, 1 3/4 yr tamoxifen
Rads necrosis
BRCA 1 & 2 negative
Trials: Early detection OVCA; 2004 low-dose testosterone for bc survivors
Diet: Primarily vegetarian organic; metformin (no diabetes), vitamin D3
Exercise: 7 days a week, 1 hr/day
No trastuzumab, no taxane, no AI
NED
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Old 02-14-2014, 04:26 PM   #10
Midwest Alice
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Re: worried: bumps on scar line - biopsy indicates allergy

Hi,

I have been away for a long time... Nice to see some old and new friends posting.
Last week I had a skin scrape on a spot near my scar line. I don't have a copy of my report yet, but over the phone they said it was atypical vascular lesson, pre cancerous, and positive for CBD 31. What ever that means. So my research starts. I am getting to my 6years date!, having IBC I am feeling blessed to be here.

Hugs to all the brave women here. If you have any insight please let me know.

.
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Old 02-16-2014, 06:09 PM   #11
Aussie Girl
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Re: worried: bumps on scar line - biopsy indicates allergy

Dear Alice,
Atypical vascular lesion is something that occurs in women who have had breast cancer and radiation. It is usually solitary but some times multiple. The lesions are usually small, 5 to 10mm. The majority are benign. They may recur if not completely excised. They are thought to very rarely progress to angiosarcoma which is a bad vascular tumor. However, angiosarcoma occurs in a fraction of a percent of breast cancer patients anyway, so the link between the two is still somewhat in doubt.
The main issue is that these lesions mimic angiosarcoma under the microscope so the pathologist needs to take care to make the right diagnosis. The CD31 is a marker of endothelial cells which line the blood vessels, proving the lesion isn't recurrent carcinoma.
I'm having my Herceptin infusion right now. I will look up some info and if I find anything else I'll let you know.
Don't get too concerned about this lesion but consider re-excision if you only had a biopsy and report any similar lesions immediately to the doctor.

Cheers

Aussie Girl
__________________
31mm Infiltrating duct carcinoma
Grade 3, ER/PR-, HER2+, Neg Sentinel nodes x 5
49mm field of DCIS
17 June '13: Screen detected impalpable mass, Mammogram neg, US.
25 June '13: Diagnosed after multiple biopsies and MRIs
28 June '13: Left lumpectomey
4 July '13: Left Mastectomy
12 August '13: Commenced TCH chemo
Mid December '13 : TCH finished. Herceptin continuing three weekly.
4 August 2014- Herceptin infusions finished.
END OF THERAPY - YAY!
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Old 02-17-2014, 04:31 AM   #12
Aussie Girl
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Re: worried: bumps on scar line - biopsy indicates allergy

Dear Alice

I can only find a rare case (about 3 cases) of possible progression of AVL to angiosarcoma. It has been thought the "vascular type" of AVL rather than the more common "lymphatic type" AVL may rarely progress.

However recent studies suggest the AVL lack a particular mutation (called a MYC mutation) which is found in angiosarcoma -so the two may not be related at all.

AVL is becoming more common, possibly because of changes in the way radiation is given these days.

Hope that helps. Overall an AVL doesn't appear to be too serious.

Aussie Girl
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31mm Infiltrating duct carcinoma
Grade 3, ER/PR-, HER2+, Neg Sentinel nodes x 5
49mm field of DCIS
17 June '13: Screen detected impalpable mass, Mammogram neg, US.
25 June '13: Diagnosed after multiple biopsies and MRIs
28 June '13: Left lumpectomey
4 July '13: Left Mastectomy
12 August '13: Commenced TCH chemo
Mid December '13 : TCH finished. Herceptin continuing three weekly.
4 August 2014- Herceptin infusions finished.
END OF THERAPY - YAY!
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Old 02-18-2014, 02:06 AM   #13
Lien
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Re: worried: bumps on scar line - biopsy indicates allergy

Alaska Angel, a friend of mine had an itchy rash very much like the one you are describing. She went to doctor after doctor but found no relief, until an allergist put her on a diet. That helped a lot, but she had a hard time sticking to the diet.

She then went to see an orthomolecular therapist, who tested her feces and concluded she had severe gut disbiosis. This seemed to be causing the development of the allergies, resulting in the itchy rash. She has been on several supplements for about six months now, and the allergies are getting significantly better.

I have no idea whether that kind of therapy would be available to you, but wanted to mention it just in case it would give you another option.

Jacqueline
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Old 02-19-2014, 10:24 AM   #14
AlaskaAngel
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Unhappy Update for me

Thanks, Jacqueline! I am exploring any possibilities and appreciate the feedback.

Prior to your post I saw the Derm NP, and asked specifically whether it would be possible to use some kind of low-dose, short-term estrogen supplement just to find out if it made any difference. Her opinion, (generalized to all patients but not specific to patients treated with chemo, radiation and antiestrogen therapy), was that there was no connection with estrogen. Specifically she said that derm docs never prescribe any hormonal drugs to any patients under any circumstances, regardless of whether the skin problem might be caused by low estrogen levels and regardless of whether the patient's history has any indications for bc.

I later obtained a copy of her clinic note of my visit with her, which noted in parenthesis her awareness of my bc dx followed immediately by her statement that there is no connection between "extreme xerosis of the skin and estrogen levels".

Her approach to my extreme dry skin problem was to prescribe cetirizine Hcl 10 mg 1 q24h, specifically Zyrtec, plus several different skin emollients applied daily to moisturize the skin. She said I might have to use it "forever". She said I could continue to use the baby oil with vitamin E and aloe in it, but only after using the emollients so that they would soak in. She said it could take up to 2 months for the cetirizine to have effect. In the meantime, she recommended cutting my fingernails (which are short to begin with), wearing gloves, and eliminating all scratching.

I asked her specifically about the numerous oval-shaped 1/2-inch "bumps" called lipomas that have arisen since the skin problem began and that are palpable under the skin in places that are especially itchy (the front part of the elbows, and on my hips) and she said there was no relationship between them and the itching. I had some other lipomas previously and those lipomas have significantly enlarged since the skin problem began. My PCP had indicated to me that perhaps the derm doc would biopsy some of them, but the NP said that if I wanted any of them biopsied they would have to be entirely removed by not a derm doc but a surgeon, and once removed then of course a biopsy of them would occur.

I have been on the citirizine, have cut my nails, have applied the skin creams, and am trying to aviod scratching. The $1/day Zyrtec helped; when I ran out, the 50 cents/day grocery store version of citirizine did not. The soothing effect of the creams lasts about 30 minutes, just in time to fall asleep (and then wake up due to itching).

I have an appt to see my PCP soon. If the recommended therapy is the only possible option, it may be necessary, but I think the question about use of low dose short-term estrogen supplementation should be explored to see if there is any validity to it, rather than taking on a band-aid approach of perpetual antihistamine and creams without even bothering to do another bx.

I am not sure what disbiosis entails and will read up on it. Since chemotherapy, radiation and anti-estrogen therapies may affect the skin and are common treatment specific to breast cancer patients, I will also be exploring whether or not something such as a sluggish gallbladder post-treatment could be a cause, since that can result in higher levels of bile salts being deposited in the skin, which causes itching. I want a bx of the skin for that, as well as possibly a bx of some lipomas (fatty deposits just under the skin).

I will post with any results.
__________________
Dx 2002 age 51
bc for granny, aunt, cousin, sister, mother.
ER+/PR+/HER2+++, grade 3
IDC 1.9 cm, some DCIS, Stage 1, Grade 3
Lumpectomy, CAFx6 (no blood boosters), IMRT rads, 1 3/4 yr tamoxifen
Rads necrosis
BRCA 1 & 2 negative
Trials: Early detection OVCA; 2004 low-dose testosterone for bc survivors
Diet: Primarily vegetarian organic; metformin (no diabetes), vitamin D3
Exercise: 7 days a week, 1 hr/day
No trastuzumab, no taxane, no AI
NED
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