Peau d'orange appearance of the skin overlying a breast carcinoma results from which mechanism?

• A Shortening of Cooper's suspensory ligaments
• B Ulceration through the areolar muscle of Sappey
• C Direct invasion of the pectoralis major fascia
• D Obstruction of dermal lymphatics with resultant skin oedema ✓

Explanation

Peau d'orange develops when tumour emboli obstruct subcuticular and dermal lymphatics, causing skin oedema while the hair follicles remain tethered and pitted, resembling orange peel. Shortening of Cooper's ligaments instead produces skin dimpling or tethering over the tumour, the best distractor here. Pectoral fascia invasion causes fixation of the tumour to the chest wall, and ulceration is a late T4 feature. Recognising that each skin sign maps to a distinct anatomical structure is the tested concept.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.