title: The distance between breast cancer and the skin is associated with axillary nodal metastasis.
abstract: OBJECTIVE
  More superficially located tumors may be more likely than deeper tumors to metastasize to the axillary nodes via the lymphatics. The aim of this study was to determine whether breast cancer distance from the skin affects axillary node metastasis, ipsilateral breast cancer recurrence, or recurrence-free survival.
  
  
  METHODS
  A total of 1,005 consecutive patients with breast cancer who underwent surgery between January 2003 and December 2009 were selected. The distance of the tumor from the skin was measured from the skin to the most anterior hypoechoic leading edge of the lesion.
  
  
  RESULTS
  In total, 603 (68%) patients had no axillary nodal metastasis, and 288 (32%) had axillary nodal metastasis. A breast cancer distance from the skin <3 mm induced more axillary nodal metastasis (P = 0.039). However, no significant correlation was observed between breast cancer distance from the skin <3 mm and ipsilateral breast cancer recurrence (P = 0.788) or recurrence-free survival (P = 0.353).
  
  
  CONCLUSIONS
  Breast cancers located closer to the skin had a higher incidence of axillary nodal metastasis. Therefore, tumor distance from the skin should be considered when evaluating a patient with breast cancer and considering the risk of nodal metastasis.
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yong Hwa
authors.initials: YH
authors.lastname: Eom
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Kim
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Chae
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
authors.forename: Sang Seol
authors.initials: SS
authors.lastname: Jung
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012867:Skin / Q000473:pathology*; D015996:Survival Rate
keywords: breast cancer; lymph node; metastasis; skin; ultrasonography