Prognosis for Isolated Skin Recurrence after Breast Cancer Treated by Mastectomy

Abstract. Isolated skin recurrence after mastectomy (ISRAM) for breast cancer is a rare event for which treatment is difficult and subject to debate. Patients The natural history of breast cancer treated by mastectomy is recovery or recurrence in the form of local or local and distant metastases. Local isolated skin recurrence (i.e. with no detected concomitant metastatic disease) after mastectomy (ISRAM) is still a rare event whose frequency is estimated at 5.2% to 9% (1, 2). It gives rise to two problems with no clear solution. The first problem relates to treatment in the absence of a current consensus on management and the diversity of clinical situations, and the second relates to prognosis (3). This paper reviews 75 records of patients presenting with ISRAM who were treated at the Eugène Marquis Comprehensive Cancer Center, Rennes, analyzing the prognostic factors of skin recurrence. Patients and Methods A retrospective study was conducted based on 75 records located using data software developed by the Eugène Marquis Comprehensive Cancer Center, covering patients presenting with ISRAM who were treated at the Eugène Marquis Comprehensive Cancer Center in Rennes from 1976 to 2006. The data were taken from consultation and operating room records, and histology results. ISRAM was defined by the first-time appearance of one or more nodules embedded in the skin of the hemithorax after mastectomy (region limited by the collarbone superiorly, the posterior axillary line laterally, the sternum interiorly and the submammary fold inferiorly). The parameters analyzed were the initial clinical features at the time of primary breast cancer treatment, the histological features of the primary tumor and its treatment, the clinical features of skin recurrence and its treatment, and disease development. The mean age of patients on initial diagnosis of cancer was 47.4 years (26 to 89 years, median 46 years). A family history of 1st or 2nd degree breast cancer was found in 29.33% of patients, and 12% had a previous history of fibrocystic mastopathy. The histological type of the primary tumor was (a) invasive ductal carcinoma (57% ), (b) invasive lobular carcinoma (11% ), (c) invasive carcinoma associated with an in situ component (29% ), and (d) carcinoma in situ (3% ). According to the TNM classification, there were 31% of T1, 31% of T2, 9% of T3 and 4% of T4 lesions, with 36% of N1 patients. Mastectomy was directly performed in 54.7% of patients and as second-line therapy in 45% of cases in the event of local recurrence after primary conservative treatment. Radiotherapy was administered to 73% of patients, either after systematic tumor resection or after primary mastectomy, in the case of a bulky lesion (exceeding 5 cm, pT3), or skin invasion (pT4). Adjuvant treatment following initial systemic treatment with chemotherapy or hormon