BREAST ULCERS

 Skin ulcer is a spontaneous erosion of skin that lasts for weeks or more. Although this is not the scientific definition but it is more practical for non professionals to identify an ulcer. Breast ulcers measure from few millimeters of diameter up to several centimeters.
A low percentage of breast ulcers are malignant i.e. potentially fatal, but it is not rare. Other causes of breast ulcers include infections and a group of auto-immune diseases. Trauma also can cause ulcers (tight bras for example).

Complications of breast ulcers:

Pain: Infection ulcers are often painful, while other types of ulcers are painless. However, many patients complain of burning sensation or itching.
Bleeding: Ulcer surface is covered by red friable sensitive tissue. Doctors call it: granulation tissue. This tissue easily bleeds on touch, but this bleeding is minimal and not dangerous.
Discharge: Most ulcers secrete minimal amount of colorless discharge, while infection ulcers secrete pus. Sometimes discharge becomes red due to bleeding or green due to infection.
Axillary lumps: Sometimes small multiple masses appear in the axilla. Doctors call them lymph nodes. In case of infection ulcers they are tender. But in case of malignant ulcers they are painless.
Disfigurement: This is important because the vast majority of breast ulcers occur in women, and they might disturb their social life.

Treatment:

This depends on the type of ulcer.
Infection ulcers are treated by the appropriate antibiotic or antifungal drugs, either systemically i.e. injection or tablets, or topically i.e. creams or ointments. Doctors may advise their patients to perform a laboratory investigation called culture and sensitivity test to identify the type of bacteria that caused the ulcer and determine the appropriate antibiotic to use. The specimen is obtained by swabbing secretions from the deepest point of the ulcer that can be reached without surgery.
Auto-immune diseases like Wegener's granuloma can be treated by immunosuppressant drugs like corticosteroids or methotrexate.
All these ulcers must be covered by a sterile dressing to protect ulcer surface from injury and infection
Malignant ulcers are signs of cancer and should be treated without delay because cancer invades more tissues every day and the chance to survive decreases by time.
After accurate diagnosis, the whole tumor and ulcer with lymphatics - if they are invaded - should be removed surgically. Many surgeons prefer to remove the whole breast with lymphatics in one mass i.e. radical mastectomy - to minimize the chance of recurrence of cancer after surgery. 
Cancer patient should receive adjuvant radiotherapy or chemotherapy after surgery.
Some doctors use chemotherapy alone without surgery if cancer is detected early before invading surrounding tissues, But this not the role.

What to do?

 Because breast ulcers harbor the danger of being malignant, so patients need to see a surgeon if it continues for more than one week.

If ulcer does not regress obviously i.e. decrease in diameter and accompanying itch and discharge- within 2 weeks of conservative treatment, then your doctor will proceed into cancer investigations like x ray mammography ,cancer markers in blood and excisional biopsy or fine needle aspiration cytology.