1814: Sir Charles Bell recognized the seriousness of a breast mass presenting with pain and skin discoloration.
“When a purple colour is on the skin over the tumor, accompanied by shooting pains, it is a very unpropitious beginning.”
1887: Thomas Bryant observed dermal lymphatic invasion by carcinoma, suggesting the obstruction could explain the gross inflammatory appearance.
“The acute oedematous infiltration of the skin and breast is met with occasionally, and it is without doubt the most acute and fatal form of cancer found in the breast. It may attack the gland much in the same way as the acute tuberculated form which has just been described, but it may do so more insidiously, or rather less actively, and appears more as a rapid oedema of the breast and skin over it, with or without retraction of the nipple, the whole gland and integuments covering it feeling to the hand infiltrated, and perhaps pitting on pressure. There may be no external redness or heat suggestive of inflammation, but only oedema, and this oedematous infiltration will probably be confined to the soft parts over the breast. In exceptional cases it will extend to a wide area. Such cases as these, like the last described, have been mistaken for inflammation, but a knowledge of the probability of this affection being cancerous should prevent such a mistake from being made.
“With this brawny infiltration of the breast and skin over it, there is an allied condition which claims description, and I have been in the habit of describing it at the bedside as one of lymphatic absorption, in which the lymphatics of the skin of the breast appear as swollen white cords radiating from the nipple, with the intermediate skin slightly thickened from oedema, but not sufficiently so to pit. These local symptoms are always associated with rapidly progressing disease, in which the original nidus not only spreads rapidly by infiltration, or “local infection,” but also by “lymphatic infection,” the lymphatics, as described, being apparently filled, if not choked, with the epithelial material which it is conveying to the lymphatic glands.
“This form of carcinoma in its clinical features is not recognised as it should be. I quote, therefore, some few examples to illustrate its different points. It is to be observed that this variety of carcinoma attacks what appears to be healthy women; indeed, many have a florid aspect of health. It spreads rapidly and kills quickly. Thus, in some cases quoted, the disease ran its course in five months. When complicated with pregnancy or lactation the disease is most active.”
Bell, C. (1814). A system of operative surgery, founded on the basis of anatomy. London: Longman, Hurst, Rees, Orme, and Brown. Vol 2: 136.
Bryant, T. (1889). The diseases of the breast. Wood’s Medical and Surgical Monographs, 4, 35-322.