Skin mets after mastectomy

To Surgeon and CCF-RN,MSN-RF
I have been reading the postings for some time. First, I appreciate your time and efforts you put in to answer our questions.  Many of us does not express this often but we do appreciate it.  
A friend of mine in Ausralia  had herceptin and taxetere for her original bc. She responded quite well, then she had a mastectomy.  Now she has recurrence to her scar.  After the scar was re-excised in September and the biopsy showed some left over tumour.  Her doctor and a second opinion from her onc in Australia both agreed to use the wait and see approach and save chemo for later.  She was only on herceptin since September. Now she found more little patches showing up. They are not sure what to do.  She said that they do not seem to think chemo is the right thing to do. Her onclogist has suggested that chemo has not been proven effective for skin mets. Her doctor was talking about MRM. The operation is major and involves cutting away muscle, chest wall and filling with fat and the skin graft. He says the result is displeasing. I voiced my opinion about systemic treatment instead of surgeory.  Now, her doctors agree that surgery is not a good idea and decided on weekly taxol and herceptin.  I  want to be absolutely sure that surgery is not the way to go.  Please advise on surgery or not. Thanks in advance.

[CCF-RN,MSN-rf]

Dear Irisme:  Unless the doctors are certain that all of the disease can be effectively resected with clean margins, one would question the wisdom of a surgical intervention.  One might ask if there is a role for local radiation in her situation.  Systemic chemotherapy would likely be recommended regardless.

[surgeon]

It's a very difficult situation, and the fact is that such recurrance usually denotes disease for which the goal is control, rather than cure. Some form of drug therapy absolutely makes sense, since there is significant risk of distant disease. Local control is not very likely to be enhanced even with the extensive surgery under consideration; although there are times when it makes sense to be as aggressive as that. Another option is chest wall radiation. It's not free of side effects, either; but overall may be less disruptive than radical excision.