Breast cancer and paraneoplastic dermatomyositis: A literature review

Abstract

Objective: Breast cancer (BC) is the most common malignancy in women. Contrastingly, dermatomyositis (DM) is a rare
idiopathic inflammatory myopathy characterized by symmetric proximal muscle weakness and skin lesions. Gottron’s papules and heliotrope are pathognomonic signs. This article aimed to describe how the diagnosis and treatment of patients
with both diseases have been performed. Methodology: As this study consists of a literature review, submission to the
Research Ethics Committee was not necessary. Articles indexed in the PubMed and SciELO electronic databases were
collected. Cross-sectional and retrospective observational studies were selected using the following descriptors: (Breast
Cancer) AND (Dermatomyositis). Finally, 19 studies were read in full and included in this systematic review. Results: An
underlying neoplasm is present in 50% of DM patients older than 45 years. A newly diagnosed DM in the latter, should,
therefore, be associated with an etiologic search of paraneoplastic origin. This may allow an early BC detection. This is
corroborated by the significant stage 1 BC detected in patients with rheumatic diseases, according to a cohort analysis.
Furthermore, cases in which DM indicated cancer recurrence have been reported. DM is associated with higher BC mortality, and the most correlated histotype is invasive ductal carcinoma. Currently, there are no guidelines or randomized
trials for the management of BC complicated by DM. Therapeutic management of DM is mainly based on corticosteroids
and immunosuppressive agents. However, previously published case reports indicated that surgical excision of the tumor is
successful, as it can stop the progression of DM and prevent deterioration of muscle function. Conclusion: BC can feature
uncommon presentations, such as paraneoplastic DM. Due to the absence of guidelines for the management of BC concomitant with DM, a multidisciplinary approach, including oncologists, dermatologists, and rheumatologists, is mandatory.