A retrospective study has been undertaken of 104 men with breast cancer, all of them having a follow-up period of at least 5 years. In 78 cases a histological diagnosis was obtained. The preferred treatment for operable cases was radical mastectomy, in which 60 per cent positive axillary nodes were found. Five-year survival is 54 per cent and the disease-free interval is 42 per cent. Local recurrence occurred in 26 per cent and 16 per cent had developed distant metastases. The overall results are similar to those in the literature with the exception of those for stage III who did better in this series. The generally held beliefs that Klinefelter's syndrome is the strongest predisposing factor to developing male breast cancer and that gynaecomastia is not a premalignant condition are supported by this study. Comparison of results from this series, with those of women of the same age having breast cancer leads to the conclusion that the prognosis in male breast cancer is no worse than for women with comparable disease.
Advances in combined transcranial and transfacial (craniofacial) approaches for malignant tumors involving the anterior skull base have demonstrated improved survival. The technique allows adequate assessment of the intracranial extent of the tumor through an appropriate craniotomy. Vital structures, such as the dura, brain, and blood vessels, can be protected or resected and reconstructed safely. An en bloc excision can be accomplished. Dural defects and/or tears are satisfactorily repaired under direct vision, ensuring a watertight closure. Finally, adequate closure of the soft tissue defect is obtained, thus segregating the cranial cavity from the potentially infected nasal cavity and the nasopharynx with a resultant decrease in morbidity. Operative mortality is low, although complication rates are high. The technique is safe and continues to be improved to reduce morbidity. To evaluate the true impact of this surgical procedure on improvement in survival as well as quality of life, a multiinstitutional registry with uniform indications is indicated. With increasing experience and well-defined indications, improvement in survival (from 50% to 60%) and reduction in morbidity (from 30% to 40%) can be demonstrated through multiinstitutional, cooperative efforts. J. Surg. Oncol. 1998;69:275–284. © 1998 Wiley-Liss, Inc.