Table 8. Examples of breast cancer-related possible therapy-associated cutaneous tumor lysis syndrome.

Ref, reference; yo, year old

Patients	Comments	Ref
Nine of 12 women	A retrospective study described 12 women with advanced infiltrating ductal breast carcinoma who had extensive cutaneous metastases and were treated with antineoplastic therapy that included bevacizumab. In nine women, patches of enlarging skin erosions developed at the cutaneous metastasis sites. In three women, the erosions remained superficial, while there was progressive peripheral growth of the erosions. However, in six women, large areas of complete skin layer loss resulted in the erosions progressing to deep ulcers and necrosis, features suggestive of cutaneous tumor lysis syndrome, with exposure of the underlying fat and muscle. The investigators concluded that bevacizumab-associated necrosis and ulceration in women with breast cancer treated with this agent was usually related to extensive tumor involvement of the skin	[47]
27 yo woman	A woman presented with metastatic invasive ductal breast carcinoma (scirrhous carcinoma) began her seventh-line therapy with bevacizumab and paclitaxel. Her nodular and partially erosive left breast tumor measured 15 × 12 × 9 cm. Within three days, there was therapy-associated cutaneous tumor lysis syndrome manifested by necrosis of all skin layers and the development of deep ulcers that exposed the pectoralis major muscle. A second treatment cycle was started; however, she died from carcinomatous lymphangitis-associated respiratory disorder. These observations suggest local (cutaneous) tumor death without systemic regression	[48]
48 yo woman	A woman with metastatic invasive ductal breast carcinoma (scirrhous carcinoma) began her third-line therapy with bevacizumab and paclitaxel. Prior to this treatment, the left chest wall had a 5-cm ulcerative lesion. After two treatment cycles, the entire cutaneous breast cancer lesion detached; the residual ulcer was 20 × 15 cm, and not only the chest wall but also the underlying muscles (pectoralis major, pectoralis minor, and anterior serratus muscle) had disappeared and part of her rib was exposed	[49]