Dermal and Epidermal Breast Calcifications

Calcifications and smaller microcalcifications are small specs or clusters of mineral deposits on breast tissues. Dermal (skin) breast calcifications are superficial and benign calcifications which are usually found on sebaceous glands of the skin. They are not visible to the naked eye nor found on a physical examination, but will likely be revealed in a breast cancer screening mammogram. But they are of no clinical consequence whatsoever. Typically, they are either discussed as an incidental finding, or not mentioned in the mammography report at all.

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Dermal and other Benign breast calcifications

Most calcifications are benign and often associated with breast fibrocystic disease or other incidental problems associated with lactation. Certain patterns and shapes of breast microcalcification are more worrisome in terms of early breast cancer development, but dermal calcifications do not fall into this category. Benign calcifications are typically larger, round or punctate, possible rod shaped or popcorn-like. It is not uncommon for dermal breast calcifications to have spherical and polygonal shapes. Some radiologists even describe dermal calcifications informally as having a unique ‘tattoo’ pattern.

Mammographic characteristics of dermal breast calcifications

Usually, dermal calcifications are readily apparent to a radiologist and they will not require biopsy. Dermal breast calcifications tend to be spherical and lucent-centered, and occur on the periphery of the breast. The seldom occur alone, but rather present in multiples and bilaterally (in both breasts). But they can also occur alone, and in these situations the radiologist might check for additional microcalcifications deeper within the breast. But if none are found, then it is usually safe to conclude that it is a peripheral dermal calcification and no biopsy is necessary. Dermal calcifications will tend to occur at the same ‘depth’.

What causes dermal calcifications?

Dermal calcifications will usually be caused by some sort of degenerative metaplastic process. They are very common, and may even be caused by trauma or sunburn. However, there is a whole range of possible skin-related contexts, including skin cancers, which could involve dermal calcifications and if there is concern the matter is best discussed with your family physician or an experienced dermatologist. However, dermal and epidermal calcifications are entirely unrelated to breast cancer.

References

1. Stephens, TW., Whitman, GJ., Breast, Benign Calcifications. Mamografia. 21 de Noviembre, 2009
2. Rosenberg RD, Yankaskas BC, Abraham LA, Sickles EA, Lehman CD, Geller BM, et al. Performance benchmarks for screening mammography. Radiology. Oct 2006;241(1):55-66.
3. Sitzman SB. A useful sign for distinguishing clustered skin calcifications from calcifications within the breast on mammograms. AJR Am J Roentgenol. Jun 1992;158(6):1407-8
4. Berkowitz JE, Gatewood OM, Donovan GB, Gayler BW. Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. Apr 1987;163(1):282.
5. Kopans DB, Meyer JE, Homer MJ, Grabbe J. Dermal deposits mistaken for breast calcifications. Radiology. Nov 1983;149(2):592-4.
6. Homer, MJ., D’Orsi, CJ., Sitzman, SB., Dermal calcifications in fixed orientation: the tattoo sign.July 1994 Radiology, 192, 161-163.
7. Sewell CW. Pathology of benign and malignant breast disorders. Radiol Clin N Am. 1995; 33:1067-1080.
8. Fajardo LL, Hillman BJ, Frey C. Correlation Between Breast Parenchyma Patterns and Mammographer’s Certainty of Diagnosis. Invest Radiol. 1988, 23: 505-8.
9. Overmoyer B. Breast cancer Screening. Med Clin North Am. 1999, 83: 1443-66.

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