Multiple primary malignant neoplasms are multiple tumors with different pathogenetic origin. They may be synchronous or metachronous. The management of these conditions represents an interesting clinical scenario. A crucial aspect is the decision regarding which tumor to treat initially, and how to schedule further treatments according to individual tumor risk. This process involves a multidisciplinary physician team to ensure favorable outcomes. We describe a case report of a female patient affected by primary synchronous tumors of the breast and pectoral skin, which raised a series of diagnostic, etiological and therapeutic issues persuading us to carry out a critical review of the literature. Multiple primary malignant neoplasms (MPMNs), or multiple primary cancers, are defined as multiple tumors with different pathogenetic origin. The phenomenon of MPMN was first described by Billroth at the end of the 19th century (1) and since then several cases of double or even triple primary malignant neoplasms have been reported (1-3). Neoplasms can be synchronous or metachronous and may appear in a single organ or in multiple organs concurrently. According to Moertel (2), synchronous neoplasms are defined as those that occur within 6 months from the diagnosis of a previous malignant tumor, and metachronous neoplasms are defined as neoplasms that appear 6 months after the first diagnosed tumor (2). Despite many changes in the definition have been proposed, the diagnosis of MPMNs that is widely accepted is based on the criteria described by Warren and Gates (3). These criteria require that: (i) each tumor must have a clear picture and histological confirmation of malignancy; (ii) each tumor must be topographically distinct and separated by healthy mucosa (at least 2 cm of normal mucosa between two tumors of the same region); (iii) the lesions must be not metastases of each other (3). In this report, we describe our recent observation and treatment of a female patient affected by primary synchronous tumors of the breast and pectoral skin. This combination, to the best of our knowledge, has never been previously reported in the literature, and it raised a series of diagnostic, etiological and therapeutic issues persuading us to carry out a critical review of the literature.