Despite the increasing use of adjuvant therapy locoregional relapse and skin metastases remain a problem in the treatment of patients with breast cancer. Topical administration of miltefosine supplements the available local treatment modalities. Especially patients with superficial lesions – no deep skin or soft tissue infiltrations, node size not exceeding 1-2 cm – may achieve clinically relevant remissions in about 40%. After superficial exulceration a scab formation and reepithelization may be expected. An attempt at topical treatment should be indicated if surgical excision and radiotherapy are no longer applicable or in case such therapy cannot be provided due to logistic difficulties. Concomitant local therapy, in addition to a systemic treatment indicated by nonskin metastases, may be meaningful and necessary. Together with surgery and radiotherapy as the treatments of choice, topical treatment with miltefosine constitutes a new treatment option which is reasonably well tolerated and can be employed in ambulatory patients. During the course of the disease the therapeutic response to skin metastases may become a major problem for patients, and additive local treatment therefore may be to improve considerably the quality of life of the patients. The position of this new treatment modality within the overall treatment approach has to be defined by an oncolog