Friday morning, 8:00 am, my first patient arrives.
A 61 year old woman with a personal history of breast cancer and a mother with postmenopausal breast cancer presents for her annual mammogram.
The routine images are obtained and the patient quietly waits in the dressing room for her results.
Reviewing the images, I see a developing nodular density in the deep subareolar region of the right breast (Images 1, 2, 3, 4).
The density has a concerning appearance and I am prepared to perform a limited breast ultrasound following the additional mammogram images.
My technologist returns to inform me that the patient has a prominent mole in the area and she has marked it for the additional imaging. A marked spot MLO and XCC view were performed.
Thankfully, the developing density corresponds perfectly with the skin lesion (Images 5, 6).
The importance of fully evaluating patients for moles or skin tags is clearly seen in this case.
Without the use of a skin marker, the lesion would have persisted and would not have been visible sonographically. A biopsy recommendation most likely would have followed, given the patient’s personal high risk as a breast cancer survivor.
Had the lesion in this patient been marked initially, additional mammograms could have been avoided.
While this patient’s images were immediately interpreted, in many situations she would have been called back for additional imaging, markedly raising the patient stress level.
Additionally, identifying the density as a mole, obviated the need for a breast ultrasound. Breast cancer patients tend to have a higher anxiety level than the general population at the time of their mammogram imaging, as they are aware of their increased risk for both recurrence or a new cancer.
With appropriate marking of visible skin lesions, both additional radiation exposure and patient anxiety can be reduced in mammography patients.
Julie Gershon, M.D.
Diagnostic Radiologist, J Gershon Breast Imaging
