A Multidisciplinary Approach to Complex Dermal Sarcomas Ensures an Optimal Clinical Outcome.

Primary dermal sarcomas (PDS) belong to a highly clinically, genetically and pathologically heterogeneous group of rare malignant mesenchymal tumours primarily involving the dermis or the subcutaneous tissue. The tumours are classified according to the mesenchymal tissue from which they originate: dermal connective tissue, smooth muscle or vessels. Clinically, PDS may mimic benign soft tissue lesions such as dermatofibromas, hypertrophic scarring, etc. This may cause substantial diagnostic delay. As a group, PDS most commonly comprises the following clinicopathological forms of dermal sarcomas: dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), dermal undifferentiated pleomorphic sarcoma (DUPS), leiomyosarcoma (LMS), and vascular sarcomas (Kaposi's sarcoma, primary angiosarcoma, and radiation-induced angiosarcoma). This clinical entity has a broad spectrum regarding malignant potential; however, local aggressive behaviour in some forms causes surgical challenges. Preoperative, individualised surgical planning with complete free margins is pivotal along with a multidisciplinary approach and collaboration across highly specialised surgical and medical specialties. The present review gives a structured overview of the most common forms of dermal sarcomas including surgical recommendations and examples for advanced reconstructions as well as the current adjunctive medical treatment strategies. Optimal aesthetic and functional outcomes with low recurrence rates can be achieved by using a multidisciplinary approach to complex dermal sarcomas. In cases of extended local tumour invasion in dermal sarcomas, advanced reconstructive techniques can be applied, and the interdisciplinary microsurgeon should be an integral part of the sarcoma board.

Reconstruction of columella and nasal vestibuli by bilateral nasolabial flaps - A case report.

INTRODUCTION AND IMPORTANCE: The nose is a common location for non-melanoma skin cancers. Resection of such cancers can result in large, multilayer defects that are challenging to reconstruct. The surgical approach is determined by multiple factors and the main goal is to obtain a satisfactory functional and aesthetic result. We present a case of reconstruction of the nasal vestibuli and columella by two transnasal nasolabial flaps. PRESENTATION OF CASE: A 66-year-old male underwent resection of a large squamous cell carcinoma in the right nasal vestibulum that extended through the columella into the left vestibulum. The resection resulted in a multilayer defect including the floor and roof of the right vestibulum, the entire columella, part of the septum cartilage and floor of the left vestibulum. The defect was reconstructed in two stages by bilateral nasolabial flaps, that were brought into the nasal cavity through incisions on the side of the nose and were used to line the vestibuli and sutured to each other medially to form the neocolumella. No complications or surgical site infections were observed. CLINICAL DISCUSSION: Transnasal nasolabial flaps can be used for larger columellar defects. The length of the flaps in our case provided enough tissue to reconstruct the columella as well as the entire vestibular linings. CONCLUSION: We describe a successful reconstruction of the nasal vestibuli and columella with two transnasal nasolabial flaps, which provided an acceptable aesthetic and functional result.

[Primary cutaneous sarcomas].

Primary cutaneous sarcomas are a heterogenous group of malignant soft tissue tumours arising in the dermal and subcutaneous layers of the skin. These tumours are rare and have a variety of clinical manifestations. They differ from deep soft tissue sarcomas in terms of prognosis, which for most types of cutaneous sarcomas is favourable. The tumours are primarily managed by complete surgical excision with margin control. The purpose of this review is to present some of these rare tumors and describe their management.

[Pyogenic granuloma].

Pyogenic granuloma, also known as lobular capillary haemangioma, is a common benign vascular proliferation of not yet fully understood aetiology. Pyogenic granuloma can occur in all age groups and affect both men and women. Although pyogenic granuloma is a benign lesion, differential diagnosis may include malignant tumours such as amelanotic melanoma, basal cell carcinoma and spindle cell tumour. Surgical excision with primary closure is the usual treatment for pyogenic granuloma/lobular capillary haemangioma and has the lowest rate of recurrence.

Renal cell carcinoma presenting as a tumor on the scalp: A case report.

INTRODUCTION: Renal cell carcinoma (RCC) is often diagnosed as an incidental finding on imaging studies and about a fourth of patients have metastases by the time of diagnosis. RCC is known to metastasize widely but cutaneous metastases are considered uncommon and are rarely the presenting symptom of RCC. We present a case of RCC presenting with a tumor on the scalp. CASE: A 65-year-old healthy man presented with a 9-month history of a growing mass on the scalp. Clinical examination revealed a pulsating, highly vascularized tumor that was excised. Histopathological findings were consistent with a metastasis from a renal cell carcinoma. Further investigations revealed a 13 cm kidney tumor with metastases to the lungs and mediastinum. DISCUSSION: Cutaneous metastasis from RCC is uncommon and is rarely the initial symptom of RCC. The lesions often have a vascularized appearance and may be clinically confused with other vascular tumors. Skin metastasis is a sign of advanced disease and prognosis is poor. CONCLUSION: An occult RCC may present with a skin lesion. Skin metastasis from RCC is an important differential diagnosis in tumors with a vascular appearance, especially in patients with a previous history of RCC.

[Mastitis].

Mastitis is defined as an inflammation of the breast and may or may not be accompanied by infection. It usually affects fertile women but can be seen at all ages and even in males. Mastitis is commonly divided into two groups: lactational mastitis which occurs in breastfeeding women, and non-lactational mastitis. A timely diagnosis and correct management is essential to avoid complications. In this review, we assess different types of inflammations of the breast and elucidate important differential diagnoses, such as inflammatory breast cancer.

[Congenital anomalies of the external ear].

This review describes congenital anomalies of the external ear, which are common and include a wide range of malformations. Attentiveness to other malformations in newborns with ear anomalies is important, as they often appear as part of syndromes such as Goldenhar syndrome, Treacher Collins syndrome and branchio-oto-renal syndrome. This review is an overview of the most common congenital anomalies of the external ear and their treatment, including microtia, constricted ears, preauricular pits, tags and prominent ears.