Background: Axillary lymph node metastasis (ALNM) is an important part of the course of breast cancer (BC), the most frequent cancer in women globally. Some studies suggest that tumor proximity to the skin may influence lymphatic spread, yet definitive correlations remain unclear. Objective: This study examines the relationship between tumor-to-skin distance and ALNM incidence in early-stage breast cancer. Patients and methods: This prospective cross-sectional research included 85 female patients who had early-stage breast cancer (T1 and T2) at Suez Canal University Hospital. Preoperative imaging, including ultrasound (US) and mammography, measured tumor-to-skin distance, which was later compared with histopathological findings. Statistical analysis evaluated correlations between tumor characteristics and ALNM. Results: The mean patient age was 53.04 ± 8.84 years, with invasive ductal carcinoma being the most common histological type (86%). The upper outer quadrant was the predominant tumor location (63.5%). ALNM was present in 55.5% of patients, with 47 cases classified as N1 and seven as N2. US measurements of tumor-to-skin distance showed no significant difference from histopathological findings (p = 0.8283), confirming its accuracy. A strong correlation was found between tumor proximity to the skin and ALNM (p = 0.0001), with closer tumors exhibiting higher nodal involvement. Additionally, tumors in the upper outer quadrant had a significantly higher risk of ALNM (p = <0.0001). Conclusion: These findings highlight the prognostic value of tumor-to-skin distance in ALNM risk assessment. Incorporating this parameter into preoperative evaluations may improve staging accuracy.