Calciphylaxis with atypical localisation in a woman with end-stage renal disease.

Calciphylaxis is a rare condition characterised by painful necroses due to microvascular calcifications. It primarily affects individuals with end-stage renal disease and affected calcium-phosphate metabolism. This is a case report of a 55-year-old woman with end-stage renal disease who developed a necrotic ulcer at the breast due to calciphylaxis. Although treated with sodium thiosulfate and hyperbaric oxygen, the ulcer progressed and multiple necrotic calciphylaxis ulcers appeared. The treatment options and wound management are discussed while focusing on indications for surgical debridement.

Risk Stratification of Local Flaps and Skin Grafting in Skin Cancer-Related Facial Reconstruction: A Retrospective Single-Center Study of 607 Patients.

Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.003), partial necroses (p < 0.001), and total necroses (p < 0.001) compared to flap reconstruction. Age and sex increased the risk of major complications (hematoma, partial or total necrosis, wound dehiscence, or infection) for FTSG, revealing that men exhibited 3.72 times increased risk of major complications compared to women reconstructed with FTSG. A tumor size above 15 mm increased the risk of hematoma and necrosis significantly. In summary, local flaps for facial reconstruction after skin cancer provide lower complication rate compared with FTSGs, especially in elderly and/or male patients. The indication for FTSG should be considered critically if the patient's tumor size and location allow for both procedures.

Don't Judge a Tumor by Its Biopsy!

Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins.

Concurrent sarcoidal granulomas and melanoma micrometastasis in a sentinel node - a case report.

Incidental findings of non-caseating granulomas and metastasis in sentinel lymph nodes are rare but cause clinical challenges. We report a case of coinciding unexpected asymptomatic lymphoid sarcoidosis and a micrometastasis in a sentinel node of a patient, who was newly diagnosed with 2.0 mm thick melanoma on the left calf.

Current surgical techniques for nipple reduction: A literature review.

BACKGROUND: Macrothelia, enlarged nipples, is a relatively uncommon condition causing psychological distress in both sexes. However, to date, there is no comprehensive comparison of the spectrum of surgical techniques for nipple reduction. This review summarises the current practices to guide surgical approach to macrothelia. METHODS: A literature review was performed using the PubMed database by searching for the following words: nipple areola plasty OR nipple areola complex plasty OR nipple areola reduction OR nipple areola complex reduction OR nipple areola hypertrophy OR nipple areola complex hypertrophy OR nipple-areola complex hypertrophy OR macrothelia AND techniques OR classification OR indications OR treatment OR reduction. Additional articles were selected after reviewing references of identified articles. RESULTS: Thirty articles were selected after applying inclusion criteria to identify prospective and retrospective studies evaluating and/or describing different techniques, outcomes, complications and patient satisfaction. Reduction of the nipple was described in 639 patients, 582 females and 57 males. The thirty articles selected were case reports and clinical observations. No systematic or unsystematic reviews were found. Five different techniques were described, namely, circumcision, amputation, wedge resection, simple grafting and flaps. Patient satisfaction rates were high. Only a few cases documented sustained ability to breastfeed after the procedure. Complication rates were low and mentioned in only few studies. CONCLUSION: All techniques resulted in high patient satisfaction and low complication rates. However, current practices are exceedingly diverse, and there is currently no common classification system, which makes comparison between surgical techniques for nipple reduction challenging. The choice of surgical technique must be based on individual assessment. Clinical guidelines are challenging owing to the heterogeneity of the studies reviewed.

[Diagnostics, treatment and prognosis in breast cancer during pregnancy].

Breast cancer is the second most common form of cancer diagnosed during pregnancy. The diagnosis and treatment of breast cancer during pregnancy requires multidisciplinary efforts to treat the cancer while protecting the foetus. Pregnancy-related changes in the breast make the diagnosis particularly challenging. Surgery is possible during all three trimesters. Chemotherapy can be administered in the second and third trimesters without increased risk of foetal malformations. Radiation, endocrine and biological therapies however, must be postponed until after delivery.

Marjolin's ulcer in a 20 years old split thickness skin graft on the knee-A case report.

OBJECTIVE: Marjolin's Ulcer (MU) is a rare cutaneous neoplasm arising in cikatrical tissue. Due to its typical clinical presentation as a non-healing lesion in scar tissue, the diagnosis can be delayed and even overlooked. METHODS AND RESULTS: We present the case of an elderly woman who developed an ulcerated, exophytic lesion in a split thickness skin graft (STSG) on the lateral aspect of the left knee. Histology showed a radically excised highly differentiated squamous cell carcinoma (SCC) with keratine pearls and a component of basocellular carcinoma (BCC). The histological picture combined with the location and long time interval since the primary surgery made the diagnosis of MU highly likely. DISCUSSION: Considering the risk of metastasis and mortality it is important to recognize the diagnosis and initiate adequate treatment. CONCLUSION: The diagnosis of MU is clinical and confirmed by pathology. The typical long delay from the primary lesion to the malignant transformation might occlude the diagnosis. As such, a thorough anamnesis is essential in a non- healing ulcerated lesion in a cikatrical area to adequately diagnose and treat the condition.

[Evaluation and treatment of nipple secretion].

Nipple secretion is a common condition; it can occur in men and women, and be uni- or bilateral. It is related to hormonal changes, physical stimulation, intracerebral processes and certain drugs, and it is divided into three types: galactorrhoea, clear/bloody or viscous. Only the clear/bloody type is an indication of breast malignancy. Malignancy should always be ruled out in the presence of breast tumours. Treatment is determined by aetiology, and can vary from patient education, medications to surgery.

Incidental Treatment of a Subclinical Chronic Tension-Type Headache by Cosmetic Use of Botulinum Toxin A: A Case Report.

BACKGROUND: Headache is a common disorder of the nervous system; chronic headache in particular may affect quality of life negatively. The pathophysiology is multifactorial and not completely elucidated. Studies have demonstrated the beneficial effects of botulinum toxin A on chronic migraine headaches, but failed to show the same effect on chronic tension-type headaches. METHODS: We present the case of a 32-year-old woman who after receiving cosmetic injections with botulinum toxin A for fine lines of the forehead experienced relief of subclinical tension-type headaches. CONCLUSIONS: Although the effect of botulinum toxin A on chronic tension-type headaches is limited, several studies demonstrate its pain-modulating effects, and as such it is worth paying attention to this potential beneficial effect when performing cosmetic injections with botulinum toxin A.

[Inverted nipples].

Inverted nipples is an anatomical variation which can be uni- or bilateral, congenital or acquired. The degree of inversion can vary from slight to severe. Treatment can be surgical or non-surgical and should depend on the degree of functional problems. Non-surgical treatment can be beneficial, does not risk affecting sensibility, spares the lactiferous ducts, and therefore does not risk any interference with breast-feeding. Surgical options should only be considered when non-surgical treatment is insufficient.