Mohs micrographic surgery: the experience of the dermatology unit of the university of Milan confirms the superiority over traditional surgery in high-risk non-melanoma skin cancers.

The constant increase in the incidence of non-melanoma skin cancers (NMSC) makes their treatment a topic of paramount interest. Because most NMSC tend to develop in visible areas such as the headneck area, it is a priority to choose the less destructive therapy and more appropriate reconstructive technique. Mohs Micrographic Surgery (MMS) represents the treatment of choice for skin tumors in critical sites, recurrent tumors and tumors with aggressive histologic features. We collected patients affected by NMSC who underwent MMS at the Dermatology Unit of IRCCS Fondazione Ca' Granda, Milan, in the period March 2017-December 2021. One hundred and fifty-nine patients were enrolled in this retrospective observational study. The excision margins were chosen based on a dermoscopic evaluation. The main histological diagnoses were basal cell carcinoma (145, 91.2%) and squamous cell carcinoma (10, 6.3%), in areas with high functional or anatomical value. 121 out of 159 surgeries did not require further enlargement after the removal of the clinically and dermoscopically visible lesion, but in 38 cases (23.9% of cases) the pathologist required at least one subsequent enlargement, due to the persistence of neoplasm at the bottom or at the margins of the lesion. Only one recurrence has been reported so far. MMS is a pathology-controlled surgery with high intrinsic value because of the low risk of recurrences and should be routinely adopted for high-risk NMSC.

Syphilitic balanitis of Follmann in a patient with a history of previous infection.

We report a case of syphilitic balanitis of Follmann arising in a man with a history of prior infection with syphilis. Few cases have been described in the literature. In our case, a man with history of multiple unprotected sexual contacts presented with erosive balanitis and painless inguinal bilateral lymphadenopathy. All tests for sexually transmitted infections (STIs) performed were negative with the exception of serology for syphilis. We made the diagnosis of syphilitic balanitis of Follmann that was confirmed by prompt resolution after treatment.

Severe Streptococcal Infection Following Cat Scratch.

INTRODUCTION: Cats can transmit bacterial infections to humans through biting and scratching. Streptococcal infections in wounds caused by cat bites or scratches rarely have been reported in the literature. CASE REPORT: The case of severe streptococcal skin infection after a 2-day-old cat scratch of the right arm, elbow, and forearm in a 68-year-old woman is presented herein. Group A ß-hemolytic streptococci (GABHS) was isolated from the wound of the patient as well as the oral cavity and claws of the cat; likewise, Escherichia coli also was isolated from the oral cavity and claws of the cat. She was successfully treated with intravenous tigecycline for 2 weeks at a starting dosage of 100 mg daily. Tetanus prophylaxis was performed. Complete remission was observed 3 weeks after beginning treatment. Follow-up visit at 32 months was negative for clinical manifestations. CONCLUSIONS: For the first time documented in the literature, GABHS were isolated from the wound of the patient and from the cat's oral cavity and claws.

Acellular dermal matrices and radiotherapy in breast reconstruction: a systematic review and meta-analysis of the literature.

The increasing use of commercially available acellular dermis matrices for postmastectomy breast reconstruction seems to have simplified the surgical procedure and enhanced the outcome. These materials, generally considered to be highly safe or with only minor contraindications due to the necessary manipulation in preparatory phases, allow an easier one-phase surgical procedure, in comparison with autologous flaps, offering a high patient satisfaction. Unfortunately, the claim for a higher rate of complications associated with irradiation at the implant site, especially when the radiation therapy was given before the reconstructive surgery, suggested a careful behaviour when this technique is preferred. However, this hypothesis was never submitted to a crucial test, and data supporting it are often discordant or incomplete. To provide a comprehensive analysis of the field, we searched and systematically reviewed papers published after year 2005 and registered clinical trials. On the basis of a meta-analysis of data, we conclude that the negative effect of the radiotherapy on the breast reconstruction seems to be evident even in the case of acellular dermis matrices aided surgery. However, more trials are needed to make solid conclusions and clarify the poor comprehension of all the factors negatively influencing outcome.

Massive de-gloving thigh injury treated by vacuum therapy, dermal regeneration matrix and lipografting.

Frequently lower limb injuries are caused by road and work accidents. The young age of those affected coupled with the anatomical and functional peculiarities of this part of the body with regards to social life during adolescence make the treatment of the leg wound complex and challenging. We present two cases of young girls, victims of serious road accidents who were treated initially with frequent wound washings, vacuum therapy to stimulate granulation tissue, then dermal regeneration matrix (INTEGRA®) and split-thickness skin grafts. After one year, both patients treated with lipofilling have shown improved cosmetic results allowing a new social life.