Epidemiology of facial skin cancers managed in a French ambulatory surgical center.

INTRODUCTION: Approximately 80,000 cases of skin cancer are diagnosed annually in France. The management of these cancers can occur in both university hospital centers and ambulatory surgery centers. Limited data exist regarding the epidemiology of cutaneous cancers treated through ambulatory surgery centers. The objective of our study is to describe the epidemiological characteristics of cutaneous cancers managed in a tertiary ambulatory surgery center. METHODS: This is a retrospective, single-center observational study. The included patients were those who underwent surgical excision of one or more skin cancers within the maxillofacial department of a tertiary ambulatory surgery center. Clinical, therapeutic, histopathological, and follow-up data (additional surgery if margins were not clear, progression, recurrence, second cancer…) were collected. RESULTS: Among the n = 1931 patients operated for a head and neck skin tumor from September 2018 to July 2022, n = 426 (22 %) were diagnosed with cancer upon histological analysis. The median age was 76 years (31-100), with a male-to-female ratio of 1/1. The most frequent locations were the nose (23 %) and cheek (20 %). Ten percent of patients had dual-site skin cancer at initial diagnosis. The most common histological types were basal cell carcinoma (77 %) and squamous cell carcinoma (18 %). Surgical treatment primarily consisted of "excision-reconstruction with local flap" (51 %) or "excision-suture" (34 %). Resection margins were mostly clear (65 %), and only six patients (2 %) experienced local recurrence or progression during follow-up. CONCLUSIONS: Skin cancers are prevalent in ambulatory practice. Surgical treatment allows for effective control of the cancer. Photoprotection, particularly in immunocompromised patients, remains crucial for prevention.

Oral migration of Dirofilaria repens after creeping dermatitis.

We report an autochthonous case of oral dirofilariasis in a 46-year-old female patient exposed in South-Eastern France. The patient first presented eyelid creeping dermatitis of one-week duration, then a sub-mucosal nodule appeared in the cheek. The entire nodule was removed surgically. Histologically, the nodule appeared as inflammatory tissue in which a worm was seen. The molecular analysis, based on cox1 and 12S sequences, identified Dirofilaria repens. Ivermectin treatment was given prior to diagnosis, while taking into consideration the most common causes of creeping dermatitis, but treatment was ineffective. The oral form of dirofilariasis is uncommon and could lead to diagnostic wandering.

TITLE: Migration orale de Dirofilaria repens après une dermatite rampante. ABSTRACT: Nous rapportons un cas autochtone de dirofilariose buccale chez une patiente de 46 ans exposée dans le sud-est de la France. La patiente a d'abord présenté une dermatite rampante des paupières d'une durée d'une semaine, puis un nodule sous-muqueux est apparu dans la joue. Le nodule entier a été retiré chirurgicalement. Histologiquement, le nodule est apparu comme un tissu inflammatoire dans lequel un ver a été observé. L'analyse moléculaire, basée sur des séquences de cox1 et 12S, a identifié Dirofilaria repens. Le traitement à l'ivermectine a été administré avant le diagnostic tout en tenant compte des causes les plus courantes de la dermatite rampante, mais il était inefficace. La forme orale de la dirofilariose est rare et pourrait conduire à une errance diagnostique.

Modeling of the human mandibular periosteum material properties and comparison with the calvarial periosteum.

Knowledge of mandibular periosteum mechanical properties is fundamental for understanding its role in craniofacial growth, in trauma and bone regeneration. There is a lack in the literature regarding mechanical behavior of the human periosteum, including both experimental and modeling aspects. The proposed study involves tensile tests of periosteum samples from different locations including two locations of human mandibular periosteum: lingual and vestibular, compared with samples from various locations of the calvarial periosteum. We propose to analyze the tensile response of the mandibular periosteum using a model, initially applied on the skin, and based on a structural approach involving the mechanical properties of the corrugation of the collagen. Two different approaches for the model parameters' identification are proposed: (1) identification from experimental curve fitting and (2) identification from histological study. This approach allows us to compare parameters extracted from the traction test fitting to structural parameters measured on periosteum histological slices. Concerning experimental aspects, we showed significant differences, in terms of stiffness, between calvarial and mandibular periostea. (The mean final stiffness is [Formula: see text] for the mandible versus [Formula: see text] for the calvaria.) About modeling, we succeed to capture the correct mechanical behavior for the periosteum, and the statistical analysis showed that certain parameters from the geometric data and traction data are significantly comparable (e.g., [Formula: see text] for [Formula: see text]). However, we also observed a discrepancy between these two approaches for the elongation at which the fibril has become straight ([Formula: see text]).

Contribution of the periosteum to mandibular distraction.

Mandibular distraction is a surgical process that progressively lengthens bone. To improve the distraction procedure and devices, the load of distraction and the mechanical strain of soft tissues during the process must be determined. We tested the assumption that it could be the periosteum primarily opposing distraction. Therefore we assessed the mechanical properties of the human mandibular periosteum and compared the stress-strain data with the torque measured on the activator during a cadaveric mandibular distraction. A 20 mm horizontal mandibular distraction was performed in 7 cadavers using standard distractors. Torque was measured with a torquemeter placed on the activation rods of the devices, providing a load (Lt) for each millimeter of distraction. In parallel, 18 periosteum samples were harvested from 9 cadaver mandibles. Uniaxial tensile tests were performed on the specimens and an estimated load (Lc) was calculated using periosteal stress-strain data and mandibular dimensions. During the distraction process, we observed an increase of the load Lt from 11.6 to 50.6 N. The periosteum exhibited a nonlinear viscoelastic stress-strain relationship, typical of biological tissues composed of collagen and elastin. The median Lc and Lt were not significantly different for the first millimeter of distraction. We demonstrated the periosteum is primarily responsible for opposing the distraction load.

Case 251: Nontraumatic Drug-associated Rhabdomyolysis of Head and Neck Muscles.

History A 21-year-old man with a history of abuse of multiple drugs and mild cognitive impairment who initially underwent treatment for excited delirium developed respiratory arrest shortly after admission and was successfully resuscitated. Unenhanced computed tomography (CT) of the head and neck and contrast material-enhanced CT of the chest, abdomen, pelvis, and complete spine were performed shortly after the initial treatment. Head and neck magnetic resonance (MR) imaging was performed 24 hours after admission. No other abnormalities were noted. There were no fractures, and there was no vascular injury in the head and neck region. The patient had no external neck injuries, congestion, or petechiae suggesting neck compression. He had no history of chronic or recurrent pain or skin rash. Urine testing was positive for cocaine, cannabis, and methamphetamine. Serum creatine kinase level was initially high (31 117 U/L [520 µkat/L]; normal, 1000 U/L [16.7 µkat/L]). Corrected calcium level was 2.22 mmol/L, and ionized calcium level was 1.09 mmol/L (lower end of the normal range). There was no acute renal failure at the initial phase, but serum creatinine levels reached 180 µmol/L 24 hours after admission, and creatine kinase peaked at 61 000 U/L [1019 µkat/L]. Urine was initially red, but the patient was not tested for myoglobinuria.

Reliability of Color Doppler Ultrasound Imaging for the Assessment of Anterolateral Thigh Flap Perforators: A Prospective Study of 30 Perforators.

Despite numerous advantages, the anterolateral thigh perforator flap suffers from the variable position and nature of its perforators. The aim of the authors' study was to assess the reliability of preoperative color Doppler ultrasound imaging for the exploration of perforator location and course of anterolateral thigh perforator flaps. A prospective cohort study involving patients for whom head and neck reconstruction was planned with thin anterolateral thigh perforator flaps was conducted. Each patient underwent a color Doppler ultrasound exploration of the thighs, in the operating room, immediately before surgery. The sonographer was the surgeon who raised the flaps. Perforators were sought according to surgical needs, and the same location protocol was followed for all of the cases, using an orthonormal coordinate system to report the passages of the perforators through the vastus lateralis aponeurosis. Between January of 2016 and January of 2017, 22 thin anterolateral thigh perforator flaps were successfully harvested. Thirty perforators were located and used. The median distance between the preoperative color Doppler ultrasound planning and the final location of the perforators was 5 mm, statistically smaller than a 10-mm threshold (p = 0.002). Color Doppler ultrasound effectively predicted the nature of the perforators in 90 percent of the cases. The median duration for perforator color Doppler ultrasound location was 3 minutes, statistically shorter than 10 minutes (p = 0.0001). Preoperative color Doppler ultrasound seems to be reliable, accurate, and compatible with a quick routine assessment during patient setup for the elevation of thin anterolateral thigh perforator flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Malignant melanoma revealed by testicular metastasi.

We report the case of an 83 years old man supported for painless indurated and nodular lesion of the left testicle. Histological analysis identified a primary cutaneous melanoma metastasis although it has never been found on physical examination. The discovery of a testicular mass should suggest first a germ cell tumor, despite in some populations (age over 60 years), other diagnosis are more frequent, including metastasis. Due to rapid disease progression and high mortality rate within a short interval, a complete staging looking for other secondary locations must be done and a multidisciplinary care and palliative involvement must also be initiated in the context of metastatic melanoma.