Background and objectives. Occult primary breast carcinoma is uncommon. Most reported series encompass a large periods of time with great variability in diagnostic and treatment approaches. The objective of the present study was to review the recent experience with this type of presentation of breast cancer in the University of Alabama at Birmingham. Methods. Retrospective review of clinicopathological data of female patients presenting with axillary metastasis of adenocarcinoma with unknown primary and normal clinical and mammographic breast exam seen at UAB between 1985 and 1998. Results. Ten patients were identified. Mean age was 56 years. Sixty per cent were white and postmenopausal. All patients had biopsy proven adenocarcinoma consistent with breast primary. All but one patient underwent an axillary dissection. Nine out of ten patients received some type of local treatment to the breast. Three of them underwent mastectomy and no invasive carcinoma was demonstrated in the surgical specimens. Six patients received radiation therapy to the breast. All patients received chemotherapy. With mean follow-up time of 48 months, two patients developed local recurrence to the axilla and four developed distant metastasis and eventually died. At last follow-up six patients are alive with no evidence of disease. Conclusions. In presence of axillary metastasis from an unknown breast primary, an extensive work-up evaluation is not necessary. An axillary dissection is recommended to provide prognostic indicators as well as local control. A breast conservation approach seems to be feasible without affect the local control and survival.