Does loupe magnification reduce the gap between the macroscopic and microscopic border of a Basal cell carcinoma?: a prospective clinical study.

OBJECTIVES: Incomplete excision of a basal cell carcinoma (BCC) remains a frustrating problem. Various attempts have been made to decrease the rate of incomplete excisions, including the use of loupe magnification. METHOD: A prospective, controlled study is presented, which was designed to evaluate whether loupe magnification (×3.5) leads to a more accurate determination of the clinical border of primary facial BCCs. The objectives of this study were 4-fold: to analyze if there was a statistically significant difference when using a loupe magnifier or not in (1) rate of incomplete excisions, (2) width of histologic margins, (3) excised surface areas, and (4) types of closure. RESULTS: Ninety primary facial BCCs in 81 patients were treated by conventional surgical excision. Forty-five BCCs (40 patients) were excised with loupe magnification, and 45 (41 patients), without. Although the number of incomplete excisions was equal in both groups (n=3), the mean histologic margin was larger in the study group (2.4 mm) compared with the control group (2.1 mm). This could illustrate the enhanced visualization by using a magnifier, which consequently results in excising a lesion with excessive unaffected skin, after adding a standard surgical margin. Furthermore, the mean surface area of BCCs was larger in the study group (103.7 mm) compared with that in the control group (76.1 mm). More defects were closed in a nonprimary fashion in the study group (n=14) compared with the control group (n = 10). However, none of these differences did reach statistical significance. CONCLUSION: Our results could implicate that the determination of the surgical margin might be influenced not only by size, location, and histologic subtype of the tumor but also by the method of tumor assessment. This means that deciding on the appropriate surgical margin might be adapted according to the method of preoperative evaluation of tumor extensions.

DIEAP Flap Breast Reconstruction Followed by Local Recurrence of Breast Cancer.

Local recurrence after an autologous breast reconstruction is uncommon. We describe 2 patients with local recurrence 3 and 9 years, respectively, after mastectomy with DIEAP (deep inferior epigastric artery perforator) flap breast reconstruction. Patients generally present with a palpable mass, pain, or other visible abnormalities. Various imaging techniques are helpful, always completed by biopsy to characterize the tumour. A repeated sentinel node procedure can be useful in staging. The treatment of the local recurrence needs to be determined in a multidisciplinary team consultation.

Where the PIP is the implant?

A 51-year-old woman, who had previous breast augmentation and a video-assisted thoracoscopic wedge resection of the lung, underwent breast implant replacement of Poly Implant Protheses (PIP) due to a loss of volume on the right side of the chest. During this procedure, no implant was found in the right subpectoral space; however, a large defect was observed in the fifth intercostal space. A computed tomography scan of the chest indicated a circular entity in the right pleural cavity, which was confirmed to be the lost implant during a subsequent video-assisted thoracoscopic surgery (VATS).

Relocation of painful neuromas in Zone III of the hand and forearm.

Painful nerves are a difficult and complex clinical problem. We describe the result of treatment by proximal relocation of 51 painful end neuromas and scarred nerves of the forearm in 33 patients. The relocated nerves included 29 superficial radial nerves, 16 lateral antebrachial cutaneous nerves, two medial cutaneous nerves and four posterior cutaneous nerves. These relocations achieved no, or only mild, pain in 100% of nerves at the original site and 94% of nerves at the relocation site. It also achieved no, or only mild, hypersensitivity in 96% of nerves at the original site and 98% of nerves at the relocation site. The technical difficulties encountered in this region, in particular on the radial aspect of the wrist, are discussed.