A Fast-Track Referral System for Skin Lesions Suspicious of Melanoma: Population-Based Cross-Sectional Study from a Plastic Surgery Center.

Introduction. To minimize delay between presentation, diagnosis, and treatment of cutaneous melanoma (CM), a national fast-track referral system (FTRS) was implemented in Denmark. The aim of this study was to analyze the referral patterns to our department of skin lesions suspicious of melanoma in the FTRS. Methods. Patients referred to the Department of Plastic Surgery and Breast Surgery in Zealand University Hospital were registered prospectively over a 1-year period in 2014. A cross-sectional study was performed analyzing referral patterns, including patient and tumor characteristics. Results. A total of 556 patients were registered as referred to the center in the FTRS for skin lesions suspicious of melanoma. Among these, a total of 312 patients (56.1%) were diagnosed with CM. Additionally, 41 (7.4%) of the referred patients were diagnosed with in situ melanoma. Conclusion. In total, 353 (63.5%) patients had a malignant or premalignant melanocytic skin lesion. When only considering patients who where referred without a biopsy, the diagnostic accuracy for GPs and dermatologists was 29% and 45%, respectively. We suggest that efforts of adequate training for the referring physicians in diagnosing melanocytic skin lesions will increase diagnostic accuracy, leading to larger capacity in secondary care for the required treatment of malignant skin lesions.

Release and Reconstruction of a Postburn Deformed Breast in a Young Woman.

Burn injuries to the anterior chest wall in the young woman may cause disfiguration or lack of development of the breasts during puberty. Often the patients are referred after puberty with an apparent lack of breast development due to firm postburn scar tissue constricting the anterior chest wall. We report a case where a young female with a postburn disfiguration and apparent diminished breast development was reconstructed successfully with incision only through the restricting burn scar, a periareolar skin excision and split-thickness skin grafting of the subsequent outburst of constricted breast tissue.

[Breast implant-associated anaplastic large-cell lymphoma]. / Anaplastisk storcellet lymfomassocieret til brystimplantater.

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare entity. Due to the lack of awareness of BIA-ALCL, patients with prior history of breast implants who present with non-specific implant-related complications might experience a delay in diagnosis and appropriate treatment of this distinct condition. There are still no evidence-based guidelines on how this condition should be diagnosed, treated or followed because of the rarity of available data. We review current literature in order to raise awareness and discuss management options of this unique clinical entity.

[Merkel cell carcinoma is a rare, aggressive neuroendocrine skin cancer]. / Merkelcellekarcinom er en aggressivneuroendokrin hudtumor.

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a poor survival rate. The low incidence and lack of characteristic manifestation of MCC often cause an incorrect diagnosis. A 92-year-old male presented with an asymptomatic, smooth lesion on the right cheek, which was initially diagnosed as a basal cell carcinoma. After histological diagnosis of MCC the patient underwent radical surgery, but developed metastases later. Attention to the diagnosis of this condition, patient history and initial presentation can provide clues in order to offer the right treatment with minimal delay.

Severe scratcher-reaction: an unknown health hazard?

Tattoos are well known to cause skin problems and the number of reported adverse reactions after tattooing has increased. Illegally imported tattoo ink is unrestrained and can contain unknown ingredients and contamination thereby posing a serious health hazard. We present a case illustrating the risk of pronounced phototoxic allergic reaction and other severe complications after using home kit tattoo ink.