Only 4.4% of patients with inflammatory carcinomas of the breast survive 5 years. The incidence of the disease is fortunately low at less than 2% of all mammary malignancies, and there is no relationship to pregnancy or lactation. Clinical diagnosis should be supplemented by searches for microscopic metastases in dermal lymphatics and for distant metastases before a therapeutic programme is planned. Combinations of local and systemic treatments best suited to each individual should be devised. The grave outlook justifies the prescription of multimodal regimens incorporating radiotherapy, mastectomy, chemotherapy, immunotherapy, and endocrine therapy from the outset. This may be regarded as providing the best chance of controlling the heterogeneous assortment of cellular types with different therapeutic responsivities within each cancer. Further collaboration between disciplines and centres is essential for the accumulation of expertise in treating this grave disease.