This picture shows the typical appearance of filed change local recurrence following a Patey mastectomy for
breast cancer. Local recurrence invariably occurs in the skin flaps adjacent to the scar. It
has been suggested that it can occur as a result of either viable tumour cells remaining at the time of
the original surgery or as a result of neoplastic change in residual breast tissue within the skin flaps.
Local recurrence has been classified as single-spot, multiple-spot or field change with the treatment and
prognosis differing for the different types. In half of all patients with local recurrence it is an
isolated phenomenon but in the remainder it heralds systemic relapse. Restaging of all patients should
occur following the detection of local recurrence.
For single-spot recurrence occurring many years after the original surgery, further local excision alone has
been reported to provide good local control. A change of systemic therapy, possibly from tamoxifen to a
progestogen or aromatase inhibitor or the addition of radiotherapy might also be considered. For
multiple-spot recurrence in patients who have not previously received radiotherapy then this might be considered
as an option. For wide spread field changes standard chemotherapy regimes are usually considered but
disease control with these is often disappointing. Intraarterial chemotherapy is often effective in some
patients. Failure to halt the progression of local recurrence can lead to cancer en-cuirase in
which the chest wall becomes encircled with a tumour mass. This is a most unpleasant and debilitating
condition for the patient. Symptoms may be improved with the use of topical metronidazole and charcoal
Blacklay P F, Campbell F S, Hinton S P et al. Patterns of flap recurrence following
mastectomy. Br J Surg 1985; 72: 917-920.
Sundquist M, Thorstenson S, Lintenberg L, Brudin L, Nordenskjold B. Indicators
of local recurrence in breast cancer. Eur J Surg Oncol 2000; 26: 357-362.