The first clinical description of Inflammatory breast cancer (IBC) was reported in 1814 by Sir Charles Bell as a “purple color on the skin over the tumor accompanied by shooting pains” (Bryant, 1889). Later in 1887, Thomas Bryant described the dermal lymphatic invasion as the cause of the inflammatory changes in the skin in 1887 (Stark & Nelson, 2000). These first reports were published more than a century ago gave precise skin and breast signs that characterized this form of breast cancer and made it a unique and a special entity. The initial quite precise and detailed impressionistic description installed the basis of the modern diagnostic criteria for IBC, which include the rapid progression of the disease in less than 3 or 6 months, which help to make the differential diagnosis with locally advanced breast cancer (LABC).

In fact, IBC is probably an ancient disease according to the short report in the year 2000 from Stark J.J. and Katz J., two Americans, the first one a medical oncologist and the second an art expert. They observed in a marble statue of a young woman the unusual appearance of the depicted left breast in this sculpture, reported as Michelangelo’s “Night”, mentioned in Michelangelo’s Medici Chapel in the Church of San Lorenzo, Florence, Italy and produced in the years 1524–1534 (Mourali et al., 1980). The young age, the skin edema, and retraction near the nipple strongly suggest the diagnosis of left IBC, clinically similar to a case of IBC diagnosed in Tunisia in 2013, five centuries later (Fig. 1).

In the 1970′s, Tunisia is known to be an area of high incidence for IBC due to the huge efforts of Pr. Nejib Mourali’s team, who initially referred to it as “rapidly progressing breast cancer”, with the first retrospective series reported in 1970 after the opening of Tunis’ Salah Azaiez Institute in 1969 (Mourali et al., 1993). It was a prolific period of an international collaborative group with the French Gustave Roussy Institute, Italian Istituto Nazionale Dei Tumori, US National Cancer Institute and the Tunisian local Salah Azaiez Institute, with dozens of published papers in high impact factor journals rendering this disease better known by the oncologists and frequent in Tunisia (Mourali et al., 1993, Rouëssé et al., 1989). The apotheosis was the completion of a positive randomized clinical trial, probably among the first trials in breast oncology, with the results showing a significant benefit of primary neoadjuvant chemotherapy followed by mastectomy or radiotherapy vs. initial surgery in IBC, which became a therapeutic internationally recognized standard (Rouëssé et al., 1989).