During a period of 10 years, 51 patients were found to have metastatic cancer in the breast. There were 44 women and seven men. Eighteen patients had carcinoma, 16 had malignant lymphoma, 14 had malignant melanoma, and three had myosarcomas. I t is interesting that 16 of the 51 patients had no prior history of malignant disease-the mammary lesion presenting as the first manifestation of an occult extramammary primary. Metastatic cancer should be suspected when a multinodular neoplasm is found in the superficial tissues of the breast. Forty-one patients had a rapidly fulminating course and died of disease. Ten patients are alive, seven with and three without apparent evidence of disease. It is concluded that earlier recognition of these tumors may lead to more rational therapy and avoidance of unnecessary radical surgery. LTHOUGH PRIMARY MALIGNANT TUMORS OFA the breast are common, tumors metastatic to the breast are rare.2,6.11 The mammary manifestation of extramammary primary neoplasms-known or unknown-should be clinically and histologically distinguished from primary mammary neoplasms.6~7.DJ0The few reported cases in the literature indicate not only the rarity of metastatic mammary tumors but show the limited experience with this condition in any given institution.

Two‐hundred and fourteen cases of histologically proven Paget's disease of the breast were seen at Memorial Hospital during the period 1950 through 1968. Ninety‐six patients were without palpable masses, clinically, and 113 had Paget's disease of the nipple with palpable masses. Two thirds of the patients without palpable masses, clinically, had noninfiltrating carcinoma, and the majority of them had negative nodes in the axilla; accordingly, they have a good prognosis. Ninety percent of the patients with palpable masses had infiltrating carcinoma, and two thirds of them had positive nodes in the axilla. According to this study, modified radical mastectomy is the treatment of choice for the patient who does not have a palpable mass. Radical mastectomy should be performed on the patient who has a palpable mass.

Treatment of mammary carcinoma by partial mastectomy rather than by total mastectomy and axillary dissection may diminish the chances of long-term cure by risking incomplete removal of all local carcinoma at the initial operation. This study was undertaken to determine by pathologic examination how often carcinoma might remain in the breast and axilla after partial mastectomy. The operation was simulated in 203 mastectomy specimens after operations for unilateral invasive carcinoma. In so far as could be determined on gross examination, the entire primary lesion was included in the quadrant which was excised in the simulated procedure. Among 100 women with primary lesions less than 2 cm in diameter, 26% had carcinoma in the breast which remained after simulated partial mastectomy. Six percent of them also had axillary node metastases. An additional 30% only had axillary node metastases. When the primary lesion was more than 2 cm in diameter, 38% of patients had carcinoma in the breast after simulated partial mastectomy, of whom 29% also had axillary metastases. After simulated partial mastectomy, carcinoma was found in 80% of breasts from patients with lesions in the subareolar area, in contrast with 25-3570 of patients with a primary carcinoma in one of the four quadrants. None of the 9 patients with medullary and colloid carcinomas that measured under 2 cm had axillary metastases or carcinoma in the breast outside of the primary quadrant. The findings suggested that a familial history of breast carcinoma or a large primary lesion may be associated more often with multifocal disease, but factors such as age at diagnosis, axillary status, and the mammogram report did not have significant predictive value for distinguishing between patients who did or did not have carcinoma in breast tissue after the primary had been removed by a simulated partial mastectomy. NTENSE CONTROVERSY HAS BEEN GENERATED I in the past several years by the proposal that total mastectomy is now an unnecessarily extensive and disfiguring operation for the treatment of primary operable invasive breast carcinoma.* Advocates of conservative surgery contend that radical mastectomy was essential in the past because many more patients presented with advanced disease.' They maintain that today the majority of patients are being treated at an Presented in part at the 27th Annual Meeting of the James Ewing Society. Maui. HI, April 8-13, 1974. The authors express their appreciation for the invaluable assistance of Miss Jane Taylor and Miss Donna Nager in the preparation of this study.Received for publication November 15, 1974. earlier stage and that it is possible to select patients who can be cured by partial rather than total mastectomy.2 Two serious difficulties must be faced in selecting patients for partial mastectomy. First, the operation should remove all carcinoma in the breast if it is to achieve maximum local control. To ensure this requires a reliable method of identifying patients with carcinoma limited to a single quadrant of the brea...

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