Paradigm change in the treatment of non-melanoma skin cancer of the auricle: reconstruction with full thickness skin grafting instead of wedge excision.

Non-melanoma skin cancer (NMSC) has become an epidemic disease and is predominantly located in the head and neck area. While historically auricular NMSCs are treated by means of a wedge excision, we describe a more elegant technique with excellent esthetical results. We conducted a retrospective cohort study of 43 consecutive patients with NMSC of the auricle who underwent reconstruction with a full thickness skin graft (FTSG). All grafts survived. Two patients (5%) showed crust formation, but fully recovered. One patient had an irradical resection for which he required a limited re-excision. All patients showed excellent esthetical results. When treating NMSC of the auricle, reconstruction with a FTSG demonstrates several important advantages. It is a relatively simple but oncological safe technique; it leads to excellent esthetical and functional outcomes, and shows high patient and surgeon satisfaction.

The value of abdominal CT scans in decision-making during chemotherapy in ovarian cancer.

OBJECTIVE: During chemotherapy of ovarian cancer many CT scans are performed to assess tumor response during treatment. The aim of this study was to determine the value of abdominal CT scan in the decision to continue chemotherapy or not, after the standard six cycles. METHODS: All ovarian cancer patients diagnosed between 1991 and 1997 were retrospectively included in the study. Clinical parameters, surgical results, diagnostic test results, and therapeutic strategies were collected from medical records. With logistic modeling those parameters were chosen that predicted best the chance of receiving additional chemotherapy. The chance of receiving further chemotherapy after six cycles based on these parameters was computed and compared to the chance based on CT scan results in addition to these parameters. Arbitrarily we defined a change of over 20% as meaningful. RESULTS: Eighteen of 50 included patients (36%) received over six cycles of chemotherapy; 29 patients (10%) were at low risk for receiving over six cycles, because they had an optimal debulking surgery and low levels of CA-125 at cycle six. The chance of receiving continued chemotherapy after taking into account positive tumor signs on CT-scan was 22%. This figure further increased to 33% if tumor presence was based on judgment of two CT scans. High-risk patients were patients with suboptimal debulking surgery or patients with an optimal debulking, but high CA-125 levels at cycle six (n = 21). Based on these parameters their chance of receiving additional chemotherapy was 71%, and after taking into account results of one or two CT-scans, the risks increased to 74% and 81%, respectively. CONCLUSION: CT scans are of no value in deciding the number of chemotherapy cycles in the initial treatment for ovarian cancer. They cost a lot of money, can add a lot of confusion, and offer no benefit over results of debulking surgery and CA-125 levels.

Management of an epidermoid cyst in the nasal tip of a child: aesthetic and surgical considerations.

BACKGROUND: A simple subcutaneous lesion such as an epidermoid cyst can present a challenge when located in the nasal tip, as regards aesthetic surgical management. Even when performed parallel to relaxed skin tension lines, a direct transcutaneous incision (commonly used for epidermoid cyst removal) distorts the nasal tip subunit, resulting in a conspicuous, disfiguring scar. This should be avoided, especially in children. CASE REPORT: A 13-year-old girl was referred by her dermatologist for diagnosis and treatment of a slowly progressive dermoid cyst located on the tip of her nose. The cyst was removed using a subcutaneous open rhinoplasty approach, leaving the aesthetic nasal tip subunit intact. CONCLUSION: For aesthetic reasons, open rhinoplasty should be considered as a treatment option in patients with subcutaneous lesions in the nasal tip.

Hormone replacement therapy, mammography screening and changing age-specific incidence rates of breast cancer: an ecological study comparing two European populations.

BACKGROUND: In 2003, for the first time, US breast cancer incidence rates have fallen. Experts argue whether this is due to the reduced uptake of screening mammography or to lower use of Hormone Replacement Therapy (HRT). This study aims to disentangle the respective impact of screening and HRT on age-incidence rates and histology of breast cancer, by comparing two populations with comparably high levels of screening mammography, but with different prevalence of HRT. METHODS: We included all invasive breast cancers recorded at the Geneva cancer registry (n = 4,909) and the Netherlands Cancer Registry (n = 152,428) between 1989-2003. We compared age-specific incidence rates and trends in histological subtyping between the two populations. RESULTS: Between 1989-1991, incidence rates increased with age in both populations. In 2001-2003, women aged 60-64 years showed highest incidence rates in Geneva, while in the Netherlands incidence rates continued to increase with age. The annual increase in ductal cancer incidence was similar in the Netherlands (2.3%) and Geneva (2.5%), but the annual increase in lobular cancer was sharper in Geneva (10%) than in the Netherlands (5%). CONCLUSION: The sharp differences in age distribution and histological subtyping of breast cancer between two European populations are not attributable to screening, since both populations have a high uptake of mammography screening. Since the prevalence of HRT use is very high in Geneva and rather low in the Netherlands, HRT may explain these discrepancies. However, other etiological factors and differences in histological assessment may also have played a role.

The place of the posterior surgical approach for lesions of the rectum.

BACKGROUND: Although there are many advantages of a posterior approach to rectal disease, these procedures are not widely accepted because many surgeons fear the postoperative complications. METHODS: The medical records were reviewed of 57 patients who underwent a posterior approach to the rectum between January 1980 and December 2002. RESULTS: Twenty-eight men and 29 women with a mean age of 70.5 (range 47-83) years underwent either a posterior transsacral (n = 52) or a transsphincteric (n = 5) procedure. Indications for surgery were benign lesions (n = 33), e.g. villous adenoma, rectal prolapse and endometriosis as well as invasive adenocarcinoma (n = 24). All patients with an invasive adenocarcinoma were classified as ASA grade III or IV. Postoperative morbidity occurred in 12 patients (21%), consisting of temporary incontinence, anastomotic leakage, wound infection, and hemorrhage. There was no mortality. During a mean follow-up of 29 (range 2-86) months, 3 patients with a villous adenoma and 2 patients who were treated for a malignant lesion had a locally recurrent lesion. CONCLUSION: We believe that a posterior approach to the rectum should be considered for various benign and selected malignant diseases, especially in case of elderly patients or patients with a compromised general condition, and has to be a part of the surgeon's armamentarium.