for ibc is it best to do on red spot of breast?

My understanding is that IBC gets worse very rapidly (like in hours or days), so I wouldn't worry overmuch about that. I would go see a breast specialist if you haven't already. GPs don't know everything

I had three punch biopsies done in different locations to confirm my IBC, and they were done by a surgeon. IBC grows in sheets, not a lump, so it's not quite as easy for them to pinpoint exactly where to biopsy. If they strongly suspect IBC they want to confirm as quickly as possible.

I don't want to worry you unnecessarily, many people are aware that IBC gets worse very quickly and say that if it isn't any worse after a couple weeks don't worry, and usually that's fine because IBC is very rare so if redness or rash is the only symptom it's probably not IBC. Mine started as a very minor rash right along the edge of my bra that lasted for weeks & I thought it was just a sweat rash so I didn't worry. It wasn't until my breast swelled to twice it's size and all of the other signs presented literally overnight (orange peel, skin thickening, heat, swollen nodes under arm and above collar, and large purple "bruise" from neck to waist on that side) that it steadily got worse by the hour. If no response to antibiotics and your lymph nodes and breast are now swollen and painful, it's a good idea to get it checked out further for peace of mind if nothing else. Wishing you the best and that it's not IBC.

Pisces yes a skin punch biopsy is best for IBC because there is typically skin involvement (which causes the inflammation). IBC is a clinical diagnosis, the pathological diagnosis would still be IDC or ILC. My pathology report did state that the cancer was sheet-like, which further supported the IBC diagnosis.

As to how they determine the exact location in normal circumstances, I'm really not sure. My case was highly unusual with how quickly it spread and by the time they did the biopsy the primary tumor had started to ulcerate, so they could not do the biopsy where the redness originated. They did two in my right breast and one in my left because by then there were signs that it had already started spreading into my left breast. Please don't let that scare you, I've been told that no one ever saw IBC spread as quickly as mine did so I'm a highly unusual case. If it is IBC, according to my MO it can grow without any symptoms for years (and undetected on mammograms), it's not like they can or need to biopsy a specific lump to find it like with other BCs because it's likely that it has already infiltrated much of the skin of that breast. Hopefully someone else with "normal" IBC will chime in with their biopsy experience.

I'm always hesitant to talk about it here because 98% of the time a person's symptoms are NOT IBC and I never want someone to worry needlessly (and I am an example worse-case scenario). I only want to say that if it's not responding to the antibiotics and your symptoms are getting worse (swollen breast and lymph nodes, etc) you should definitely keep pushing to see what's causing it. Hopefully it is just something minor.

Lori

I've had at least six biopsies and the breast surgeon or the radiologist (usually the head of radiology because the breast surgeon requested him/her) did all the biopsies. I wasn't aware that PA's even did biopsies. Biopsies are tricky--I'd hold out for the surgeon or radiologist do it--and even they miss things occasionally.

There are several types of skin biopsies, the punch is most invasive because it uses a circular cutter that also takes out some of the tissue beneath the skin and it typically requires a stitch or two to close the hole. Very different from the kind of skin biopsy my husband had for his skin cancer when just a small piece of skin was shaved off.

OMG yes get thee to UC Davis. That's what you meant, right? Davis? As in Davis, CA? You might need to check with your insurance to make sure they're in your network. I hope they are. That is one of the best places you can be in California.

You want to go here: https://www.ucdmc.ucdavis.edu/cancer/about/index.h...

Check with your insurance that they are in network (or call UC Davis Comprehensive Cancer Center directly). Assuming they are, tell your clueless family practice that you need a referral to a BREAST SURGEON at UC Davis.

You'll get this back on track fast!

A punch biopsy, as far as I know, is only done on skin. The dermatologist is a skin expert -- so yes, they will do it right. Don't worry about that.

The lymph node would not be done by the dermatologist and would be farther along in the process I think.

It sucks that you can't go to UC Davis. Me either. Now I'm thinking you should call your insurance, because "you can't go to a breast surgeon unless you're diagnosed with cancer" is ridiculous. That is the person who does the diagnosing! It's like saying: "you can't go to a dentist unless you're diagnosed with a cavity." Or: "You can't go to an OB/GYN unless you're diagnosed with cervical cancer." What is wrong with these people?

I hope to all that is good that you have NO cancer anywhere in your body. But your symptoms are concerning and you need to see the correct specialist. The good news is that a dermatologist will be smart enough to see what is going on, do the punch biopsy, and then refer you wherever he/she feels like you should go. So when do you see the dermatologist?

Oh Pisces I hate that you're going through this. Your doctor and insurance are acting inexplicably, -- as in I just don't understand what is wrong with them.

Answer these questions for me:

1. What insurance do you have, and is it a PPO or HMO?

2. What happened to seeing the dermatologist?

3. What is a "diagnostic center" that you mentioned in the earlier posts?

4. Is your breast still so swollen you can't fit it in your bra? Has the swelling gotten better or worse? Is your breast very red? What does the skin look like?

5. You didn't see a family MD, just the PA, right? Can you get in to see the actual MD? Either way, what does the PA seem to think it is?

I have to go get an MRI of my back right now (if it's not one thing it's another), but I will check for your answers when I get back.

Please don't be depressed (well, okay, eat ice cream) -- get determined instead. This is just the price we pay for being alive: constant alertness, constant willingness to fight back.

Hi Pisces! So glad to hear from you, and I hope your headache is feeling better. I'm so glad you got to see an actual doctor to feel your lymph nodes and tell you they were fine! Yes, we can worry ourselves into a panic attack sometimes.

It's funny because I think an MRI is more expensive than a bunch biopsy, so that is weird the insurance company is going that way. However, an MRI is MUCH less invasive than a biopsy, so that part is good!

The definitive diagnosis for IBC is a punch biopsy. That is the only way to see what is going on in the skin. But it never hurts to get an MRI, and it sounds like your symptoms are leveling out if not even improving a little! So yay for MRI!

Now that I know what Sutter is, I think I understand your earlier post. So here is the deal: Sounds like they referred you to a Sutter Diagnostic Imaging Center, which does Xrays, Mammograms, and MRI's and nothing else. So the imaging center would've been confused when you asked about a biopsy. Your nurse coordinator might've been willing to help, but didn't know where you needed a referral to (not reassuring, but okay I understand now). If asked in the future, you want to see a breast oncological surgeon; that is who does the punch biopsy, orders additional tests likes MRIs, and can diagnose breast cancer. Here is an example of a breast surgeon (we abbreviate that on this site as "bs"), and she is associated with Sutter Health and so probably takes your insurance: https://www.sutterhealth.org/find-doctor/dr-lisa-m...

I think you can get the MRI and by then your symptoms will have made themselves known for sure. If you need to see someone in the future, that is the type of person you want to see.

As for me, I hurt my back, and so I got an MRI of my low back on Friday. I've had many MRIs before (even a breast MRI), so I'm used to them. I love how they always say: "Are you claustrophobic?" And I'm like: "Not unless you put me in a small narrow confined space like a coffin and tell me I can't move," hahaha. This machine was really small, and I'm 5'11", so the tech was like: "I'm not sure if you'll fit, we'll have to try it," and I'm like great. My arms were resting against the inside the whole time! I'll get the results next week.

I'm not sure if you've had an MRI before, but the breast MRI was especially difficult for me, even though you go in feet first. Something to do with the position of your arms and not being able to move. If you need to, do what I do: clarify with the MRI tech ahead of time, and just say: "If I push the button and ask you to take me out of here, will you do it?" They will always say yes. It just helps to hear them say it! Then, realize that the MRI is doing NOTHING to you, and in fact is less damaging than an Xray. Sometimes it helps to pretend you're in a video game haha because of the sounds of the magnets adjusting in the machine. Other times I do yoga breathing and think about grocery lists, to-do lists, dreams and goals. I start out nervous and end up falling asleep!

Finally, realize that no one on here, even one who has "doctor" in their signature line, has seen your symptoms -- so they can't tell you what is going on with you (and there is a doctor here who is a retired radiologist; he's not a breast surgeon or an oncologist, so take his advice the same way you take mine: with a grain of salt). I think it is GREAT NEWS that your symptoms are leveling out or even improving, and I think that means there is nothing to worry about! After your MRI, if your symptoms haven't improved enough, I can help you get to see the right specialist (I've worked in insurance for years, plus I've had to navigate HMO's, PPO's, etc. for years as a patient).

In any event, regardless of whether you had an infection that is clearing up after the antibiotics (I know from experience it can take a while for the skin to recover after being very red) or we need to keep pursuing a diagnosis, it is important to watch Friends! That is my prescription, and I'm qualified to give it to you. Start at the beginning and bingewatch (if you get up to 20 times from beginning to end you might need to watch something else, but then.... no just start over). If things feel really desperate, go to youtube and search "Friends bloopers," especially "Friends bloopers pivot" to see my favorite blooper. Watching the actors dissolve into hysterics brightens even the worst mood!

And know that you have friends here who have been through every possible scenario, including being afraid and it turns out it was nothing. We will be here for you from beginning to end.

p.s. I lived in Davis when I was little and my mother worked in the library at UC Davis. I went to North Davis Elementary School for Kindergarten and First Grade!

Make sure to look up the Friends blooper with "pivot", where Ross, Rachel, and Chandler are trying to get the couch up the stairs -- and the actors can't stop laughing. So funny. Well we will be with you in your pocket tomorrow for your MRI!