Primary squamous cell carcinoma (SCC) of the breast is a rare condition that has been reported in the literature for over 70 years. We present a series of five cases and discuss management of this condition. METHODSFive (5) primary squamous cell cancers of the breast were identified from the Strathfield Breast Centre database which has prospectively recorded 1658 breast cancers for the period 1989-1999. These records were reviewed, the criteria for inclusion as primary squamous cell cancers were verified and the histopathology was reviewed. CASE REPORTS Case 1A 69-year-old woman presented with a large fungating mass, filling the lateral half of her right breast and a large clinically involved right axillary lymph node. She also presented with mid-thoracic back pain. Computed tomography (CT) scans confirmed the large soft tissue mass in the right axilla but also revealed a right-sided pleural effusion and extensive vertebral body destruction. Bone scans confirmed widespread metastatic carcinoma, and a core biopsy of the breast confirmed squamous cell carcinoma. The patient died of her distant metastatic disease while receiving palliative radiotherapy. Case 2A 71-year-old woman presented with a large cystic mass in her left breast. Aspiration of the cyst resulted in resolution of the mass, and cytological evaluation revealed occasional large degenerate atypical and vacuolated cells of uncertain significance together with macrophages and inflammatory cells. The mass recurred twice over the ensuing 2 months and was subsequently excised. Histopathology showed a cystic mass containing a poorly differentiated squamous carcinoma. The patient proceeded to the completion of mastectomy and in-continuity axillary dissection. Of the 25 axillary nodes examined, none contained metastatic disease. The patient remains alive and disease-free four years postoperatively. Case 3A 50-year-old woman presented with a fungating right breast mass. The mass was fixed to the chest wall but investigations revealed no evidence of metastatic disease. Fine needle cytology and subsequent core biopsy revealed squamous cell carcinoma. She was treated initially with chemotherapy (5-fluorouracil and cisplatinum) followed by radiotherapy. She did not complete therapy due to poor compliance, and when she presented several months later she was noted to have a mass measuring 8 cm in diameter, fixed to the chest wall and clinically involving axillary nodes. Investigations again failed to demonstrate any evidence of spread outside the axilla and after extensive discussions a Halsted radical mastectomy was carried out together with excision of part of the chest wall, removing the third to sixth ribs. A Goretex graft repair of the chest wall and a latissimus dorsi rotation flap with split skin graft were required for reconstruction. Local excision of the tumour was deemed histologically clear from both the chest wall and axilla with only one of the 16 lymph nodes examined containing metastatic SCC. Despite this treatment though, the chest wall tumour recurr...

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