Problem: A 64-year-old retired nurse comes to the office with skin changes on her right breast for 3 months. She denies any trauma to her breast. Her past medical history includes high blood pressure and abdominal surgery for colon cancer. Her aunt died of ovarian cancer and her father died of colon cancer. Her mother died of a stroke. The client denies tobacco, alcohol, or drug use. She is a widow and has three healthy children. On examination her breasts are symmetrical with no nipple discharge. Her right breast has a 1.5 inch by 1 inch patch of thickened skin with enlarged pores in the 5 o'clock position. The remainder or her heart, lung, abdominal, and pelvic examinations are unremarkable. What is the most likely cause of this skin change in her circumstance?