Report on immediate irradiation of a rapidly growing sarcoma of the scalp prior to wound closure.

Cutaneous sarcomas are primarily treated with extensive surgery, and occasionally require adjuvant radiation therapy following complete wound healing. Thus, sarcoma surgery leads to large and deep wounds, and the initiation of adjuvant radiation therapy depends on the time required for defect closure. We present the case of a male patient with pleomorphic sarcoma of the temporal skin, which was treated with multiple wide and deep excisions, instant application of an Integra(®) bilayer, and immediate radiation therapy prior to wound closure. The objective was to investigate the usefulness of a dermal substitute (Integra(®) ) in accelerating the effect of adjuvant radiation therapy on scalp defects after tumor surgery. A ring-shaped skin area - at risk for recurrence - around the Integra(®) bilayer was irradiated with a total of 59.4 Gy. No necrosis, infection, or major radiotoxicity was observed, and a subsequent split skin graft following radiation therapy remained fully vital until complete healing. In conclusion, a combined procedure consisting of sequential tumor surgery and subsequent application of a dermal substitute in conjunction with immediate initiation of adjuvant radiation therapy is, in principle, possible, and may permit innovative therapeutic options in dermatooncology and dermatosurgery.

Giant verrucous carcinoma of the lower extremity in women with dementia.

We present the case of an 81-year-old woman with dementia and a giant exophytic ulcerated tumour, which covered most of the lower leg and the dorsum of the foot and emitted a foul smell. The patient had chronic venous insufficiency for 30 years, and previously (appr. 20 years ago) had a squamous cell carcinoma in the same location (right lower leg) that could be treated surgically. The dermatopathological examination of a large excisional biopsy revealed a highly differentiated verrucous carcinoma (formerly referred to as papillomatosis cutis carcinoides). Pathologically modified lymph nodes (suspicious of lymphatic metastases) were observed. Possible treatment options (surgery, intralesional and systemic treatment) were discussed. Finally, due to extension, location of the tumour and the age and co-morbidities of the patient, a decision was made to perform radiation therapy.