Diagnostic and treatment challenges of inframammary crease breast carcinomas.
To review one surgeon's experience with tumours of the inframammary crease. Individually reviewed cases were identified from a prospective database. Of the 550 patients treated between January 2000 and January 2005, six patients were found to have carcinomas of the inframammary crease (IMC). The features identified from these cases included diagnostic confusion with sebaceous cysts delaying diagnosis and early involvement of the dermis and chest wall resulting in management issues related to local T staging. Lymphoscintigraphy showed drainage to bilateral, contralateral or ipsilateral axillae as well as the internal mammary chain. The anatomy and histology of the IMC are reviewed, as is the available published work on IMC breast tumours. By virtue of their location, IMC tumours invade the dermis and chest wall early. Despite this, they do not seem to behave as T4 cancers. Their lymphatic drainage is a cross between patterns observed for breast parenchymal and skin primaries, making sentinel node lymphoscintigraphy essential. The clinical cases presented highlight these peculiarities of IMC breast cancer.