Late spontaneous rupture of the extensor pollicis longus tendon after corticosteroid injection for flexor tenosynovitis.

INTRODUCTION: Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported after trauma, rheumatoid arthritis and sports. Rupture may also occur as a consequence of the use of anabolic steroids for recreational purposes, or systemic steroids for the treatment of a variety of medical conditions. CASE REPORT: We present a case report of a woman affected with a spontaneous EPL tendon rupture resulted 14 months after a corticosteroid injection for flexor tenosynovitis, "trigger finger," of the thumb. The edges of the tendon were debrided and sutured using figure of eight stitch and a running locked stitch. In addition multiple specimens were sent to Pathology. DISCUSSION: Duplay in 1876 described spontaneous rupture as a problem of mechanical and pressure phenomena. Another cause of EPL rupture is related to the development and persistence of inflammatory processes seen in patients with medical illnesses such as rheumatoid arthritis. There have been no reports in the literature to date of spontaneous EPL tendon rupture in the late period after steroid injection. Tendon ruptures in the hand usually occur one or two weeks after a corticosteroid injection, and the affected tendons are usually in neighbouring areas.

Superficial leiomyosarcoma of the glans: report of a case and literature review.

Primary leiomyosarcomas of the penis are rare. Clinically and pathologically, these tumors fall into two groups: superficial and deep. Superficial lesions usually are low grade and show a limited tendency toward distant metastasis. In contrast, deep-seated tumors usually show a more aggressive behavior associated with a poor prognosis. A 62-year-old man with a superficial leiomyosarcoma of the glans penis is reported.

Metatypical carcinoma of the head: a review of 312 cases.

BACKGROUND: Metatypical cell carcinoma (MTC) is a quite rare malignancy accounting for 5% of all non melanoma skin cancers, with features of basal cell carcinoma and squamous cell carcinoma. It can be described as coexistence of basal cell carcinoma and squamous cell carcinoma with no transition zone between them. AIM: Our review identified a correlation between gender and MTC affected region. MATERIALS AND METHODS: We performed a retrospective study of 312 consecutive patients, diagnosed for MTC localized on face and scalp. Statistical analysis was made to determinate most affected areas, gender prevalence, average age, presence of ulceration and infiltration and peripheral clearance rate. RESULTS: A relevant difference came out between two genders. χ2 test emphasized a relation between males and the presence of carcinoma on the scalp. In addition a strong correlation between mixed subtype and ulceration was evident. A strong relation between intermediate subtype and positive surgical margin was found; this data could identify a more aggressive behavior of intermediate type. CONCLUSIONS: In our findings an important correlation between sun exposition and this tumor was found. Moreover, due to the difficulties that can occur in preserving the aesthetic subunits in the surgical treatment of these regions, the prevention of this pathology has an important role.

Nasal reconstruction with the two stages vs three stages forehead flap. A three centres experience over ten years.

INTRODUCTION: In nasal reconstruction all anatomic layers as cover, lining, and support, have to be replaced to restore proper aesthetics. Forehead skin has been acknowledged as the best donor site to resurface the nose. Traditionally forehead flap reconstruction is performed in two stages, but Millard described an intermediate third stage between flap transfer and pedicle division. This study compared the two methods. MATERIALS AND METHODS: The study enrolled 31 patients undergoing total or subtotal nose reconstruction between January 2001 and January 2012. 20 patients underwent to the two-step technique (2S Group), and 11 the three-step technique (3S Group). Thickness of the flap was measured in three different areas. A plastic surgeon not involved in the study completed an evaluation questionnaire to assess aesthetic satisfaction (VAS = 1-10). RESULTS: The total number of procedures performed (including revisions) ranged from 3 to 6. The average number of procedures performed in group 2S patients was 4 (range: 3-6) in the group 3S was 3.46 (range: 3-5). VAS mean values were studied with t Student test and were found to be significant. DISCUSSION: The timing of thinning of the flap and detachment of the pedicle varies among Authors. There are generally two trends: defatting of the flap before the pedicle transection, performed usually 3 weeks from flap harvesting and defatting a few months after disconnection of the pedicle. We think this technique is suited for defects including underlying structures and particularly for all those defects located in the distal part of the nose (tip and nostrils).

Secondary lipofilling after breast reconstruction with implants.

BACKGROUND: Several Authors have reported on the use of lipoinjection as a low-risk and low-morbidity procedure that gives good results for the correction of soft-tissue defects. AIM: The purpose of this study was to review our caseload of fat grafting after breast reconstruction with prosthesis. PATIENTS AND METHODS: Between January 2008 and December 2011, 20 patients were treated for breast asymmetries with secondary autologous fat injection after nipple-sparing, skin-sparing and skin-reducing mastectomies breast reconstruction in our Departments. Exclusion criteria was postoperative radiotherapy. In order to assess aesthetic satisfaction, patients and an independent plastic surgeon filled an evaluation form (VAS = 1-10) preoperatively one and six months after surgery. RESULTS: In postoperative days no major complications occurred. Donor sites looks completely healthy and no scars were evident. The average values of aesthetic satisfaction in patients (VAS) were 5.2 (range 3-7) preoperatively, 7.9 (range 5-9) one month post-operatively and 7.2 six months postoperatively (range 5-9). Values reported by the surgeon team were an average of 4.9 (range 4-6) preoperatively, 7.6 after one month (range 6-9) and 7.1 after six months (range 5-9). CONCLUSIONS: Acquired contour deformities of the reconstructed breast are relatively common and independent from the technique used. Therefore, they present a frequent therapeutic challenge to reconstructive surgeons. Lipomodelling offers an "easy to perform" and predictable cosmetic solution to these patients. An objective examination of aesthetic results, in addition to our clinical analysis shows a significant improvement of cosmetic outcomes; moreover, all patients were satisfied for their final appearance.

Prognostic significance of tyrosinase expression in sentinel lymph node biopsy for ultra-thin, thin, and thick melanomas.

BACKGROUND: Investigate if the tyrosinase mRNA expression may be predictive of the outcome on ultra-thin, thin, and thick melanoma patients. AIM: In our study, we sought to correlate tyrosinase mRNA expression to the outcome in a group of 71 patients with thick, thin and ultra-thin melanomas. MATERIALS AND METHODS: 71 patients with melanomas underwent a SLNB (sentinel lymph node biopsy) at the "Sapienza" University of Rome. Among these, 38 patients had thin melanomas, while the other 33 patients had thick melanomas. In every patient's sample histology, immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) was completed. We then correlated tyrosinase mRNA expression to the statistical analysis of the outcome of patients. RESULTS: Positivity of histology was found in one patient (1.4%), immunohistochemistry in five patients (7%), and tyrosinase in 52/71 (73.2%). Thickness and tyrosinase positivity were predictive for disease progression (p < 0.05). The median follow-up was 58.24 months. There were recurrences and/or deaths in both groups of patients. CONCLUSIONS: Nodal metastasis in melanoma is uncommon, especially in patients with thin melanomas. In this study, histology and immunohistochemistry were found to be non predictive for the risk of nodal metastases, while instead, tyrosinase m-RNA expression appeared to play a role in highlighting those patients with a risk of disease progression. Moreover, no differences among the thin melanoma groups of patients (0.30-0.75 mm and 0.76-1.00 mm) were observed.

An experience on primary thinning and secondary debulking of anterolateral thigh flap in head and neck reconstruction.

OBJECTIVES: The antero-lateral thigh flap (ALTF) has become one of the workhorses of reconstructive procedures of the head and neck. The cosmetic result of this flap is uncertain during the main reconstructive procedure, so free flap contouring in head and neck reconstruction following cancer ablation is usually performed at the end of therapy. To obtain an adequate symmetry of the flap a safe thinning during the primary inset or a secondary defatting may be performed. PATIENTS AND METHODS: The study includes 45 patients underwent reconstruction with ALTF for head and neck tumors. Patients were divided into two groups: Group 1 (20 patients underwent a primary thinning of the flap), Group 2 (25 patient underwent a secondary debulking of the flap). Patients were evaluated in terms of total number of cosmetic reconstruction procedures performed, hospital stay and aesthetic satisfaction. RESULTS: Epidemiological analysis showed an average age of 51 years old in patients. Patients were affected by squamous cell carcinoma in 33 cases. Within Group 1, 14 patients underwent surgery only once, 5 underwent surgery twice and one patient three times. In group 2, 8 patients underwent surgery once, 10 patients twice, 3 patients three times and 4 patients four times. Considering total of hospital stay, the average length of stay was 18.83 days in the group of patients subjected to primary debulking, versus 23.67 days in the group subjected to secondary defatting. CONCLUSIONS: The ALT flap is a safe and reliable free flap for head and neck reconstructive surgery. As showed in the study and in previous reports, the thinning of the flap is a safe procedure, without increasing the flap complications and allowing an immediate symmetry of the recipient site contour. Furthermore, ALTF thinning reduces major defatting revisions requiring general anesthesia and the total number of secondary procedures.

Fibroepithelioma of Pinkus: variant of basal cell carcinoma or trichoblastoma? Case report.

INTRODUCTION: Fibroepithelioma of Pinkus (FeP) is a rare tumor that most often affects women aged between 40 and 60 years. Clinically FeP presents as a soft, usually solitary, polypoid or papillomatous well circumscribed tumor of skin color. It is typically located to the trunk and extremities. CASE REPORT: A 75 year old male presented to our Department complaining for the presence of a lesion of the dorsal region. His medical history was free except for several basal cell carcinoma (BCC) surgically excised. Clinical examination revealed a pigmented lesion in the back. The lesion was surgically excised and histopathology showed of a fibroepithelioma of Pinkus. DISCUSSION: Currently, FeP is considered a rare variant of basal cell carcinoma, with characteristic histopathological features, although this view is somewhat controversial as some authors considered FeP to be a variant of trichoblastoma. The pathogenesis of FeP is still under investigation. It is thought that a mutation in the tumor suppressor gene TP53 might predispose to the development of FeP. CONCLUSIONS: Our case is interesting for two reasons. First, in our case FeP is pigmented. Moreover we present a case of Fep in a patient with a history of BCC, a finding that supports the classification of fibroepithelioma of Pinkus as a variant of basal cell carcinoma.

Back to basics with distal thumb reconstruction. Easy management of the incomplete amputation.

Thumb reconstruction has always been challenging for hand surgeons. The disability can severely influence the working and social life of the patient, even if just the distal phalanx is affected. Revascularization is the best surgical option for incomplete distal amputation, although microsurgical reconstruction, sometimes, could be not feasible. A simple basic-skills-based reconstructive method, that takes into account the length preservation and a short recovery should be advocated. We treated 14 incomplete distal thumb amputations with bone exposure, classified as Hirase zone IIA-IIB. The distal thumb was held by a short tissue islet, nor neurovascular bundle, nor dorsal vein was included. Patients were assessed for skin and bone healing, length of thumb shortening, and time of return to full occupational activity. QDASH score was evaluated along with a two-point discrimination test. The outcome was fair in all 14 patients. Partial distal thumb necrosis was observed in six cases (40%); they healed by secondary intention. Finger shortening had a mean of 6.9 mm (range, 6-8 mm), mean interphalangeal joint motion was 48 degrees (range,45-55 degrees). The median static two-point discrimination was 7.1 mm (range, 6-9 mm), the mean quick DASH score was 1.8 (range, 0-4.5). All patients returned to work within a mean of 4.3 weeks (range, 4-5 weeks). The follow-up period was 12 months. Length preservation, fast recovery and easy return to manual work, above all, are the keystones of our successful procedure. Whether the revascularization is not executable, we provide a reliable and simple method to grant a functional thumb.

Axillary web syndrome in women after breast cancer surgery referred to an Oncological Rehabilitation Unit: which are the main risk factors? A retrospective case-control study.

OBJECTIVE: Axillary web syndrome (AWS) is a complication of surgical procedures in breast cancer (BC) patients. This condition with poorly understood incidence and etiology is characterized by the locoregional development of scar tissue, leading to subcutaneous cording, motion impairment and pain. The early identification of patients at risk for AWS would improve their clinical management. Here, we sought to characterize the prevalence of and the risk factors associated with AWS in BC women after surgery. PATIENTS AND METHODS: All patients with BC that underwent axillary surgery referred to an Outpatient Service for Oncological Rehabilitation were retrospectively collected. These women were assessed two weeks after the surgical procedure for their clinicopathologic features, type of therapeutic interventions, and AWS presence, laterality, pain, localization, cords type, and number of cords. RESULTS: Altogether, 177 patients (mean aged 60.65 ± 12.26 years) were included and divided into two groups: AWSPOS (n=52; 29.4%) and AWSNEG (n=125; 70.6%). Patients with tumor N ≥1 (OR=3.7; p<0.001), subjected to mastectomy, axillary lymph node dissection (ALND) and chemotherapy showed significant correlations with AWS onset (p<0.05). The range of shoulder motion limitation (OR=11.2; p<0.001) and the presence of breast cancer related lymphedema (OR=3.5; p=0.020) were associated with AWS. CONCLUSIONS: Mastectomy, ALND, chemotherapy, low staging tumors, shoulder range of motion limitations, and BCRL represent risk factors for AWS onset. Realizing new strategies for assessing the individual risk of AWS is a crucial clinical need to improve the health-related quality of life of BC survivors.

Three-dimensional laser scanning as a reliable and reproducible diagnostic tool in breast cancer related lymphedema rehabilitation: a proof-of-principle study.

OBJECTIVE: In this study, we aimed to assess the reproducibility and reliability of a three-dimensional laser scanner (3DLS) in measuring the upper limb volume of BRCL women undergoing a 2-week complete decongestive therapy (CDT). PATIENTS AND METHODS: 3DLS and CM were used to measure the upper limb volume in a cohort of BCRL women before (T0) and after (T1) a 2-week CDT. We evaluated: a) correlation between 3DLS and CM at both time points; b) level of agreement and the consistency of the different measurements at both time points; c) correlation between the inter-rater operator analysis in terms of total limb volume differences before and after rehabilitative treatment of both circumferential method and laser scanning 3D in breast cancer related lymphedema patients. RESULTS: Taken together, 43 BCRL women (age 51.1 ± 5.4 years) were included. Both 3DLS and CM showed a significant inter and intra-operator correlation in the arm volume measurement at both time-points (T0: r2=0.99, p<0.0001; T1: r2=0.99, p<0.0001). 3DLS showed a strong correlation with CM (r2=0.99, p<0.0001) in terms of volume measurement and provided greater intra-operator correlation (r2=0.92 vs. 0.62) in detecting volume variations after the treatment (T1-T0). CONCLUSIONS: 3DLS confirmed to be highly sensitive, cheap and easy-to-use in the evaluation of the upper limb volume in BCRL women before and after a rehabilitative treatment. These findings suggest that augmented reality technologies might be very useful in oncological rehabilitation.

Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

Antibiotic therapy of transaxillary augmentation mammoplasty.

BACKGROUND: Capsular contracture is the most common complication and the main cause of dissatisfaction after augmentation mammoplasty, for both the patient and the plastic surgeon. The formation of fibrous tissue around the prosthesis alters the form or the consistency of the implant, thus modifying the breast shape, its contour and its softness. The initial satisfaction with the achieved aesthetical result is then transformed into great dissatisfaction, due to the presence of a shapeless and undesired mass. PATIENTS AND METHODS: The following study considered data collected between 1998 and 2007. Sixty-seven female patients (aged between 35 and 53 years) who suffered from mammary hypotrophy and had undergone submuscular augmentation mammoplasty were enrolled. All the implanted prostheses were round and texturized, with a volume of 250 cm3 to 450 cm3. The patients underwent pre-, intra- and postoperative antibiotic therapy in order to prevent clinical and subclinical infection of the implants. RESULTS: The follow-up ranged from a period of two to nine years. All patients were examined during the first antibiotic administration and again subsequently, after 1, 3, 6 and 12 months, to evaluate the results in terms of capsular contracture. Of all patients, 90% presented a degree I Baker's classification, the remaining 10% a degree II. Not one of the patients treated showed grade III or IV capsular contracture nor was there any need to remove the prosthesis during the examination period. CONCLUSION: It is clear that a main role in capsular contracture is played by the infectious process, with the activation of specific inflammatory cells. Interfering with the infectious process can prevent fibrotic reaction evolving into capsular contracture. Although the process causing capsular contracture is multifactorial, our study showed a favourable response can be achieved when using antibiotic therapy associated with the transaxillary approach.

Postsurgical antithrombotic therapy in microsurgery: our protocol and literature review.

OBJECTIVE: Despite the improvements reached by microsurgeons in the last 30 years, postoperative complications still occur and most of them are the result of venous thrombosis at the pedicle anastomosis. Primary prevention of thrombosis is mandatory and anticoagulant therapy in the preoperative and postoperative period is widely used. Still, there is a lack of consensus in the literature about the best postoperative protocol for microsurgical reconstruction. The authors aimed to review the postoperative antithrombotic regimens described in literature focusing on their effects and risks, and moreover, share their experience. MATERIALS AND METHODS: The authors performed a literature review of postsurgical antithrombotic protocols applied in reconstructive microsurgery. Research on PubMed server was performed typing the terms "antithrombotic", "postoperative", "microsurgery", "free flap pedicle", "anticlotting", "anticoagulant". RESULTS: The authors described the postoperative standardized pro-weight pharmacological protocol applied in their unit: a combination of dextran and heparin. They inhibit more than one pattern of coagulation in order to stop platelet aggregation and thrombin action and, in the meantime, contending fluid loss with plasma expansion. CONCLUSIONS: Nowadays, a non-standardized practice, based on experience, is applied by microsurgeons in postsurgical care; the authors performed a review of the combined antithrombotic therapies described in the literature. A standardized pro-weight pharmacological protocol is proposed; it allows to increase blood flow by volume expander action (Dextran) and thrombin inhibition (Heparin). Still, coagulation cascade and platelet function have a wide variability among humans, as well as the effect of drugs. Achieving an optimal antithrombotic effect and minimizing adverse reactions meantime remains a challenge.

The value of clinical diagnosis of digital glomus tumors.

Glomus tumors are benign neoplasms that differentiate from the glomus apparatus. This neoplasm is clinically characterized by a typical symptomatological triad: paroxysmal pain, pinpoint pain and hypersensitivity to cold. The diagnosis is usually clinical, but can be confirmed by instrumental tests such as X-ray, MRI, selective arteriography and most commonly by ultrasound, with or without Doppler. Surgical resection of the glomus tumor is the definitive treatment with resolution of all symptoms. From 1997 to 2007, 21 surgically-treated cases were reviewed and here we report the clinical assessment that was used. The nine most recent cases of glomus tumor underwent surgery after clinical assessment alone. In our opinion clinical examination is the most effective method to diagnose this type of tumor and in selected cases it may be sufficient to undergo surgical therapy.

Nipple-sparing bilateral prophylactic mastectomy and immediate reconstruction with TiLoop® Bra mesh in BRCA1/2 mutation carriers: A prospective study of long-term and patient reported outcomes using the BREAST-Q.

BACKGROUND: Although demand for prophylactic mastectomy is increasing over time among women at a high risk for breast cancer, there is a paucity of studies on long term patient-reported outcomes after this procedure. METHODS: Between January 2011 and January 2015, 46 patients documented BRCA1/2 mutation carriers, eligible for prophylactic nipple-sparing mastectomy (NSM) and immediate breast prosthetic reconstruction were registered at our Institution. Patients underwent NSM and subcutaneous reconstruction with implant covered by a titanium-coated polypropylene mesh (TiLoop®). The BREAST-Q questionnaire was given to patients prior to surgery and at 1 and 2 years follow-up points. Capsular contracture was evaluated by Baker scale. Surgical outcomes along with the changes in BREAST-Q score were analyzed over time. RESULTS: Complications were reported in only one case and after two years the capsular contracture rates were acceptable (grade I: 65,2%; grade II: 32,6%; grade III 2,2%). At one year and two year follow-ups patients reported high rates in the measures of overall satisfaction with breasts (72,5 and 73,7 respectively), psychosocial well-being (78,4 and 78,6), sexual well-being (58,8 and 59,4), physical well-being (77,6 and 80,6) and overall satisfaction with outcome (75,7 and 79,7). A statistically significant increase in all BREAST-domains from the preoperative to the postoperative period was reported at one and two years follow-ups (p < 0,05). CONCLUSION: Following bilateral prophylactic NSM and immediate subcutaneous reconstruction with TiLoop®, patients demonstrated high levels of satisfaction and quality of life as measured by BREAST-Q. 2-years outcomes confirmed high patient comfort with increased scores from the preoperative baseline level.

Debulking of free myocutaneous flaps for head and neck reconstruction using an arthroscopic shaver.

Most reconstructive surgeons prefer a myocutaneous free flap for head and neck reconstruction due to its bulk and superiority in bacterial suppression. To obtain proper symmetry and contouring in the head and neck region, ancillary procedures usually have to be performed. Eleven head and neck cancer patients underwent resection and reconstruction with myocutaneous flaps that resulted in unacceptable facial contouring. Delayed flap debulking with an arthroscopic shaver was performed. All 11 patients were satisfied with their facial contouring and symmetry after one session of debulking. There were no complications such as flap necrosis, seroma or haematoma. This novel technique done under local anaesthesia is effective for debulking myocutaneous free flaps and removing fibrotic tissues. It is simple, safe and produces a reliable and satisfactory outcome.

Allergic contact dermatitis to synthetic rubber following breast augmentation.

Allergic reactions associated with silicone injection and implant were examined in a 50-year-old woman with a granulomatous reaction following breast silicone-gel prosthesis rupture who developed a delayed hypersensitivity to rubber compounds. Patch tests with SIDAPA, dental, and rubber series as well as open tests with latex, silicone and non silicone tubes, open application test with silicone gel, and skin prick test for aero and food-allergens were performed. Total and specific serum IgE measured by CAP-FEIA. Skin tests revealed a delayed-type hypersensitivity to thioureas, thiuram mixture and platinum. Specific IgE to natural rubber latex were found. Allergic contact dermatitis from thioureas, thiurams and platinum might be under-diagnosed, as they are not tested as part of the standard patch test series. Clinicians should consider this diagnosis in patients submitted to several cosmetic treatments.

Is the prognosis and course of acral melanoma related to site-specific clinicopathological features?

OBJECTIVE: Acral melanoma is an uncommon type of melanoma in Caucasian patients. However, acral melanoma is the most common type of melanoma in African and Asian patients. Comparison analyses between hand-acral melanoma and foot-acral melanoma have been rarely reported in the literature. Acral melanoma is an uncommon melanocytic tumor characterized by an intrinsic aggressiveness, with specific histological and clinicopathological features. Acral melanoma involves the palms, soles and sub-ungueal sites. PATIENTS AND METHODS: A total of 244 patients with acral melanoma were included in our analysis. The current study was performed in three different medical centers: Sapienza University of Rome, San Gallicano Institute of Rome and University of Magna Graecia (Italy). The Kaplan-Meier product was used to estimate survival curves for disease-free survival and overall survival. The log-rank test was used to evaluate differences between the survival curves. Assuming that the effects of the predictor variables are constant over time, the independent predictive factors were assessed by Spearman's test and subsequently data were analyzed performing Cox proportional-hazard regression. RESULTS: In both univariate and multivariate analyses Breslow thickness (p < 0.0001) and ulceration (p = 0.003) remained the main predictors. General BRAF mutation was detected in 13.8% of cases. We found that median Breslow value and the percentage of recurrences were similar in hand-acral melanoma and foot-acral melanoma, as well as there were no differences in both short and long-term. CONCLUSIONS: The absence of differences in survival between hand-acral melanoma and foot-acral melanoma shows that the aggressiveness of the disease is related to distinct mutational rate, as well as to anatomical site-specific features, rather than to the visibility of the primary lesion.