Peau d'orange in advanced breast cancer results primarily from which of the following?

• A Shortening of the suspensory ligaments of Cooper by tumour infiltration
• B Tumour embolisation of subdermal lymphatics with tethering of the skin at hair follicles and sweat duct openings ✓
• C Direct invasion of the dermis by carcinoma cells producing diffuse thickening
• D Obstruction of the thoracoepigastric vein causing venous congestion of the overlying skin

Explanation

Cancer cells block the subdermal lymphatic channels, so lymph accumulates in the dermis while the skin anchored at follicles and sweat duct orifices cannot swell, producing the orange peel appearance. Shortening of Cooper ligaments produces skin dimpling or retraction instead, which kills option A as the tempting distractor. Venous obstruction gives diffuse erythema rather than the pitted texture.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.