ESR1 and breast cancer: SCAND most commonly occurs in older males along the milk lines of the trunk and is composed of nested tumor cells in the dermis with neuroendocrine differentiation and estrogen receptor (ER) positivity and may mimic breast cancer metastases.4, 5, 6 It can metastasize to lymph nodes and distant organs, especially in tumors greater than 2 to 3 cm.5