Systemic and locoregional therapies for cutaneous metastases from breast cancer: state of art and new frontiers in treatment approach

Cutaneous metastases from breast cancer, although relatively uncommon, represent the most frequent form of skin metastases overall and pose a significant clinical and therapeutic challenge. Their presence classifies the disease as stage IV, typically prompting the initiation or modification of systemic treatment. However, current clinical guidelines do not distinguish between cutaneous and visceral metastases, which may lead to unnecessary alterations in systemic therapy—even when visceral disease remains well controlled—potentially compromising an otherwise effective regimen. This review provides a comprehensive overview of systemic and loco-regional treatment options for cutaneous breast cancer metastases, including current guidelines stratified by tumor subtype. Special attention is given to loco-regional therapies such as electrochemotherapy, radiotherapy, surgical excision, photodynamic therapy, intralesional agents, and topical treatments, all of which can be integrated with systemic therapy to improve local disease control, reduce symptoms, and enhance patient quality of life. We propose an integrated and personalized therapeutic model that combines systemic and loco-regional approaches, supported by a decision-making flowchart designed to assist clinicians in optimizing treatment strategies. By adopting a multidisciplinary perspective, this approach aims to improve both local and systemic disease management, clinical outcomes, and patient well-being. Further research is warranted to refine therapeutic combinations, establish standardized protocols, and fully realize the clinical benefits for patients with metastatic breast cancer presenting with cutaneous involvement.