Recurrence in the Skin

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QUESTION: After two years of chemo, my sister has been given six months to one year to live. Upon discovery of the breast cancer, surgery was not an option. It had spread to the lymph nodes. Doctors have done everything possible. My question is: The cancer is coming through the skin and I need to know what to do. We have contacted hospice, and pain medication is available, but I'm worried about the best care that I can give her.

ANSWER: Thank you for sharing your concerns about your sister. I am so sorry that she has had to suffer so much, and that you have suffered too at her side the whole way with her. You are already doing so much, just being there for her. That is so important. Hospice can be incredibly helpful too. For her, the connection to people that care about her, and helping her to do things she cares most about and be the person that she is, will be most helpful.

When cancer grows in and around the skin, it can break through the surface and form a rash of tumor or lumps. They may bleed and ooze fluid, sometimes with an odor. This can be uncomfortable. Treatment usually involves radiation. If your sister had radiation before, sometimes additional radiation can be done along with hyperthermia (using heat to the area of involvement). Chemotherapy and hormonal therapy may be able to help too.

Perhaps these treatments have already been tried without significant relief. You mentioned that hospice is getting involved. If this is the case, then maybe your sister has decided not to pursue additional treatment. Medication for comfort will be essential: There are many options to ease pain. Depression can also respond nicely to treatment. Much can be done to help her through this difficult time to a place where she can have more peace. Your love and being there is now making and will always make a world of difference to her. There isn't anything else like "sister love"—have two sisters myself and I know its power. I wish you and your sister the best there is, plus more.

—Marisa Weiss, M.D.

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