Axillary metastases from an unknown primary source.

The appropriate therapeutic approach is considered in patients who present with carcinomatous metastases in the axillary lymph nodes and in whom the site of the primary tumor remains obscure. Eight patients with axillary lymph node metastases are reported, in five of whom the location of the primary tumor could not be established. In three patients the primary growth was ultimately found to be in the adjacent breast. Early death occurred in only one patient, and in this instance the primary site proved to be in the breast. The remaining seven patients have all shown a relatively good prognosis when compared with those in similar series reported in the literature. The conservative policy of using radiotherapy alone for such cases, and the more aggressive approach of blind radical mastectomy of the adjacent breast, are both rejected. Instead, the more conservative sector mastectomy of the upper outer quadrant of the ipsilateral breast is proposed as a diagnostic procedure. Should this, together with general investigation of the patient, fail to detect the primary tumor, therapeutic axillary block dissection followed by radiotherapy is then advocated. If the primary tumor is found in the breast on sector mastectomy, a modified radical mastectomy of the affected breast should be performed and followed by irradiation.