<prompt> Carcinoma breast stage 4b involves all exceptNipple retractionSkin ulcer over the swellingDermal edemaSatellite nodule  <response>: Staging of carcinoma breast TX-Primary tumor cannot be assessed T0-No evidence of primary tumor Tis-Carcinoma in situ TisDCIS - Ductal carcinoma in situ TisLCIS - Lobular carcinoma in situ TisPagets - Pagets disease of the nipple NOT associated with invasive carcinoma andor carcinoma in situ DCIS and or LCIS in the underlying breast parenchyma. Carcinomas in the breast parenchyma associated with Pagets disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Pagets disease should still be noted T1-Tumor 20 mm in greatest dimension T1mi-Tumor 1 mm in greatest dimension T1a-Tumor 1 mm but 5 mm in greatest dimension T1b-Tumor 5 mm but 10 mm in greatest dimension T1c-Tumor 10 mm but 20 mm in greatest dimension T2-Tumor 20 mm but 5 cm in greatest dimension T3-Tumor 50 mm in greatest dimension T4-Tumor of any size with direct extension to the chest wall andor to the skin ulceration or skin nodules T4a-Extension to chest wall, not including only pectoralis muscle adherenceinvasion T4b-Ulceration andor ipsilateral satellite nodules andor edema including peaudorange of the skin, which do not meet the criteria for inflammatory carcinoma Both T4a and T4b T4d-Inflammatory carcinoma Note: Invasion of the dermis alone does not qualify as T4 Note: Inflammatory carcinoma is restricted to cases with typical skin changes involving a third or more of the skin of the breast. While the histologic presence of invasive carcinoma invading dermal lymphatics is suppoive of the diagnosis, it is not required, nor is dermal lymphatic invasion without typical clinical findings sufficient for a diagnosis of inflammatory breast cancer. Ref: Schwazs principles of surgery 10th edition Pgno: 631 