Skin Thickening and Vascular Lesions

Thickening of the skin of the breast can be a clinical presentation associated with both benign and malignant processes. The range of skin thickness can vary, but 2 mm is frequently used on mammography as the upper limit of normal. Inflammation, edema, and fibrosis are all relatively common causes of thickening of the skin of the breast; however, it can also be associated with malignancies such inflammatory breast carcinoma, invasive lobular carcinoma, and angiosarcoma. The pattern of skin thickening, other associated features on imaging, and the clinical history are all necessary to make a diagnosis. Vascular lesions represent a broad but rare group of neoplasms arising from the network of arteries, veins, and lymphatics of the breast parenchyma or skin and subcutaneous tissues. Benign lesions such as hemangiomas and lymphangiomas are frequently congenital and usually diagnosed in childhood. Malignant vascular tumors typically have a concerning imaging appearance, often with ill-defined margins and avid contrast enhancement. Benign tumors are commonly well-circumscribed and hypovascular. However, even with imaging features suggestive of benignity, on initial presentation a biopsy is often necessary to exclude malignancy.