A large ulcerated fungating breast lesion.

Digital Object Identifier: 10.1188/04.CJON.76-78 Mrs. S is a 60-year-old widowed woman who arrives in the emergency department via ambulance after collapsing at home. Her sister states that Mrs. S has been complaining of nausea and vomiting, polyuria, thirst, and pain in her right leg for several days. Her sister also notes that Mrs. S is lethargic and has become increasingly confused. Mrs. S has no health insurance and has not seen a healthcare provider in more than three years. Laboratory studies are drawn, IV fluids are started, and when Mrs. S has become more responsive, her past medical history is obtained. Mrs. S states that, during her last physical examination with her primary care provider (PCP) approximately three and a half years ago, a lump was detected in her left breast. Her PCP said it could be a cyst and referred her for a mammogram. The mammogram showed a questionable abnormality in the left breast, and because Mrs. S had never had a mammogram in the past for comparison, she was told she needed to return for additional mammography views and an ultrasound. Mrs. S never returned for the additional tests because she did not have health insurance. The mammography center sent two notices for follow-up, but again, she felt that the lump was a cyst and she could not afford the examinations. She currently works part-time at a discount store, but the company does not offer health insurance, and Mrs. S cannot afford to purchase individual insurance on her salary. She was unable to afford the additional examinations or return to the provider’s office for follow-up. She has not received any medical care since that time. When providing her family and social history, Mrs. S states that her mother died of breast cancer at age 58 and her father Shannon M. Haller, RN, BSN A Large Ulcerated Fungating Breast Lesion