Background: The aim of this study is to evaluate the relation between proximity of breast cancer to the skin and incidence of axillary nodal metastasis in order to clarify a new guideline in treatment of early cancer breast. Methods: This study includes 50 female patients with early cancer breast (T1 and T2). All patients underwent breast ultrasonography (U/S) with special confirmation on the breast cancer distance from skin surface (radiological distance) in addition to pathological assessment of the distance (pathological distance) after surgical excision and its correlation with radiological distance. Breast conservative surgery (BCS) with axillary clearance was done for 46 patients, while 4 patients underwent modified radical mastectomy (MRM). Results: This study showed that the more proximal the cancer from the skin, the higher the incidence of axillary lymph node (LN) metastasis, and the cut off radiological distance was 1.55cm while cut off pathological distance was 1.5 cm. It also proved that U/S is an accurate and reliable method in a assessing the breast cancer distance. Conclusion: Our results revealed that breast cancers located closer to the skin surface have a higher incidence of axillary LN metastasis.