A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion.

Spindle cell squamous cell carcinoma (SpSCC) is a biphasic tumor composed of squamous cell epithelial and spindle cell mesenchymal components, both of which are malignant. Cutaneous SpSCC can cause diagnostic and therapeutic difficulties because of its rarity, heterogeneity, morphological similarity to other cutaneous spindle cell neoplasms, and uncertain pathogenesis and prognosis, particularly when the squamous cell carcinoma component is minimal or missing. Intransit metastasis and satellite lesion (satellitosis) constitute a spectrum of non-nodal regional metastases. Here the author reports the first known case of cutaneous SpSCC presenting with intransit metastases and a satellite lesion, which were exceptionally aggressive. A 77-year-old female patient presented with a 3× 3× 0.5 cm mass on her right cheek. Despite wide excision and postoperative radiation, the patient resulted in local recurrence and multiple distant metastases within 3 months. If many high-risk factors-particularly satellitosis and in-transit metastases are observed in a tumor with epithelial to mesenchymal transition, then further wide excision and adjuvant chemoradiation should be considered early in the treatment process. A multidisciplinary approach could be the key to cure the most aggressive malignancies of the skin, as in other organs.

Shortening of Incision by "Pinch and Turn-Over Technique" in the Treatment of Axillary Osmidrosis.

BACKGROUND: The pinch and turn-over technique was developed to minimize the incision in the manual subdermal excision of apocrine glands in axillary osmidrosis for the best cure and fewest complications. METHODS: Through a 2-cm-long incision, peripheral subdermal tissue was excised by the technique under direct vision using intravenous anesthesia and tumescent technique. Ninety-nine axillae in 50 patients including seven secondary cases were operated on from 2009 to 2018. Long-term follow-up (average 30.3 months) could be done on 40 patients with questionnaires consisting of four-point ordinal-scale questions regarding osmidrosis grade, hyperhidrosis grade and satisfaction. For systematic review regarding incision length, 220 articles from 1962 to 2018 were reviewed with the search terms "osmidrosis" or "bromhidrosis." RESULTS: Thirty-five and 30 of 40 respondents (87.5% and 75.0%) had excellent or good postoperative results in osmidrosis and hyperhidrosis grade. Postoperative improvement of osmidrosis grade (from 2.53 to 0.80) and hyperhidrosis grade (from 1.88 to 0.95) was statistically significant (p < 0.01). Thirty-four patients (85.0%) reported very satisfactory or satisfactory. Hematoma (2.0%), hyperpigmentation (5.0%), infection (5.0%) and noticeable scar (2.5%) were rare. Necrosis of flap margins was frequent (27.3%) but necessitated revision in two cases (2.0%). Among eleven articles found to describe incision length in pure manual subdermal excision, this technique provided the shortest incision compared with eight direct subdermal excision methods with an average incision length of 5.0 cm. CONCLUSIONS: This technique offers an open, direct and selective approach with a short incision. It could maintain the best efficiency while neutralizing negative side effects of conventional manual subdermal excision for axillary osmidrosis. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .

The merits of mannitol in the repair of orbital blowout fracture.

BACKGROUND: One of the main concerns in orbital blowout fracture repair is a narrow operation field, due mainly to the innate complex three dimensions of the orbit; however, a deep location and extensive area of the fracture and soft tissue edema can also cause concern. Swelling of the orbital contents progresses as the operation continues. Mannitol has been used empirically in glaucoma, cerebral hemorrhage, and orbital compartment syndrome for decompression. The authors adopted mannitol for the control of intraorbital edema and pressure in orbital blowout fracture repair. METHODS: This prospective study included 108 consecutive patients who were treated for a pure blowout fracture from January 2007 to October 2012. For group I, mannitol was administered during the operation. Under general anesthesia, all patients underwent surgery by open reduction and insertion of an absorbable mesh implant. The authors compared postoperative complications, the reoperation rate, operation time, and surgical field improvement between the two groups. RESULTS: In patients who received intraoperative administration of mannitol, the reoperation rate and operation time were decreased; however, the difference was not statistically significant. The total postoperative complication rates did not differ. Panel assessment for the intraoperative surgical field video recordings showed significantly improved vision in group I. CONCLUSIONS: For six years, mannitol proved itself an effective, reliable, and safe adjunctive drug in the repair of orbital blowout fractures. With its rapid onset and short duration of action, mannitol could be one of the best methods for obtaining a wider surgical field in blowout fracture defects.