Preputial melanoma.

BACKGROUND: Melanomas of the glans penis, prepuce, and the corpus of the penis account for less than 1% of all melanoma cases. Due to this rarity, there is currently no standard treatment approach. CASE DESCRIPTION: We present the case of a 59-year-old patient with tumorous formations in the prepuce area. Histology was lacking at presentation. Medical history contained excision of a single formation with the character of a viral wart in the same area 1 year previously, with electrodesiccation for relapse a few months later. Due to the appearance of new bumps, the patient presented to the Onkoderma polyclinic. Dermatological examination revealed two nodular tumor formations: one with an erosive surface in the area of the prepuce and one subcutaneous lesion in the area of the right cavernous body. Differential diagnosis included Merkel carcinoma, dermatofibrosarcoma protuberans, anaplastic T/B cell lymphoma, and achromatic melanoma. Histology showed epithelioid cell infiltration and immunohistochemistry was positive for S100 protein, HMB 45, and melan A. Achromatic preputial malignant melanoma was diagnosed. The subcutaneous formation in the area of the cavernous body was defined as an in-transit metastasis. Penectomy under spinal anesthesia was planned. CONCLUSION: The prognosis for penile melanoma patients is currently poor, probably because of delays in diagnosis. Histopathologic evaluation after excision should be standard to prevent possible severe consequences such as penectomy and partial penile amputation.

Tumorous formation of the forehead.

T­cell non-Hodgkin's lymphoma (NHL) represents approximately 10% to 15% of all lymphomas in Western countries. We present the case of a 16-year-old girl with nodular erosive tumor formation on the forehead within the previous 3-4 months and clinical evidence of cervical and submandibular lymphadenopathy in parallel. Tuberculosis verrucosa cutis, lupus vulgaris, cutaneous leishmaniasis, pyoderma faciale, sporotrichosis, infected insect bite, B­cell lymphoma, and atypical acneiform eruption were considered in the differential diagnosis. The patient has undergone therapy with oral ciprofloxacin (2â€¯× 250 mg/d) for 10 days and oral amoxicillin/clavulanic acid (2â€¯× 1 g/d) for 7-8 days, followed by oral clindamycin (2â€¯× 300 mg/d) and oral rifampicin (2â€¯× 300mg/d) for 4 weeks-all without any improvement. Unfortunately, disease progression was observed. Histologic examination revealed evidence of peripheral T­cell non-Hodgkin's lymphoma, and the subsequent immunohistochemical study confirmed the diagnosis, showing positive CD3 and CD4 expression and negative CD8, CD20, CD30, CD43, and ALK1 expression. Based on CT, lymph node involvement was found above and below the diaphragm, such that T­cell lymphoma stage 4E was concluded. CHOEP chemotherapy treatment was initiated, with a favorable clinical outcome after the first cycle.

Granulomatous slack skin mycosis fungoides developing simultaneously with sarcoid-like lesions in a patient with repeated anabolic injections in the past?

We present a 32-year-old man with successful treatment and remission of mycosis fungoides of both axillae in 2016 after PUVA therapy and systemic and local administration of corticosteroids. Subsequently, in 2017, the patient also achieved remission of a T-cell CD 30 positive, ALK-1 negative large-cell lymphoma of a retroperitoneal and inguinal lymph node after chemotherapy and radiotherapy. One year later, in 2018, the patient presented to our clinic with progression of skin lesions in both axillary areas and the appearance of а tumor in the right gluteal region.Dermatological examination showed livid-to-erythematous, partly sclerotic plaques in the right inguinal area, cutis laxa-like plaque formations in the right axillary region with similar but less-developed changes in the left axillary fold, a solitary subcutaneous tumor formation affecting the entire right gluteal region, and enlarged, palpable lymph nodes in the right para-axillary area. Biopsies were obtained from an axillary lesion and the surgically removed axillary lymph nodes, and histological examination revealed changes of granulomatous slack skin in the axilla and reactive inflammatory changes in the lymph nodes. Histology of gluteal tissue showed a "foreign body" type of reaction with sarcoid-like features, where the patient in the past have been injected with anabolic and steroidal drugs. Herein we describe a patient with simultaneous occurrence of granulomatous slack skin type mycosis fungoides and a sarcoid-like reaction. The question remains open whether this represents the so-called sarcoidosis-lymphoma syndrome or, more likely, granulomatous slack skin MF associated with a sarcoid-like reaction of "foreign body" type. The possibility that disturbance of tissue homeostasis by incorporation of certain adjuvants within injections (for example) in the past might have been an inducer of cutaneous T cell lymphoma and sarcoidosis/sarcoid like lesions seems reasonable but also speculative.

Eosinophilic Fasciitis - Report of Three Cases and Review of the Literature.

BACKGROUND: Eosinophilic fasciitis is a rare fibrosing disorder of muscle fascia with rapid onset of erythema, induration, oedema and tenderness affecting extremities bilaterally. CASE REPORT: We report three cases of eosinophilic fasciitis in 3 females aged 64, 65 and 73 years, in two of them in association with morphea. They fulfilled the proposed diagnostic criteria. Associated malignancies could be excluded in all of them. They were treated by systemic corticosteroids. In the two females with associated morphea higher prednisolone dosages and a combination with methotrexate was necessary. CONCLUSIONS: Eosinophilic fasciitis is a differential diagnosis of systemic scleroderma. Response to treatment is often delayed. Systemic corticosteroids are the first line therapy. Patients with associated morphea need combined drug therapy, in our patients with methotrexate. There is no close correlation between laboratory signs of inflammation and clinical response to treatment.

Dermal Pleomorphic Sarcoma of the Scalp - Report of Two Cases.

BACKGROUND: Neoplasias of the UV-exposed head-and-neck area of the elderly include non-melanoma skin cancers of various origin. CASE REPORT: We report two cases of rapid growing exophytic scalp tumors on chronic sun-damaged skin, in one case with a tendency of bleeding. The tumours were removed by wide surgical excision with 3D margin control, and the resulting defect was covered by a meshed split skin graft. Histopathologic examination disclosed a dermal pleomorphic sarcoma in both cases. The staging was unremarkable in both patients. CONCLUSIONS: Sarcomatous tumours of the scalp should be completely excised with a 3D margin control. Dermal pleomorphic sarcoma is a more aggressive variant compared to atypical fibroxanthoma despite some similarities.

A Painful Step - Pendulating Plantar Eccrine Poroma.

BACKGROUND: Eccrine poroma is a benign tumour of eccrine duct epithelium. The usual clinical presentation is nodular. CASE REPORT: We present a 78-year-old man with a painful pendulating flesh-coloured malodorous plantar tumour. Differential diagnoses included telangiectatic granuloma, acrochordon, basal cell or squamous cell carcinoma, cylindroma, amelanotic melanoma, and verruca. Microbiological investigations identified numerous bacteria including Corynebacterium striatum, Streptococcus dysgalactiae, Staphylococcus aureus, Citrobacter koseri. We performed surgery since the tumour hampered his mobility. Histopathology revealed a well-circumscribed tumour composed of cuboidal cells with eosinophilic cytoplasm. Healing was unremarkable. CONCLUSIONS: Pendulating plantar eccrine poroma is a rare clinical presentation of this benign adnexal tumour. Often asymptomatic, in some cases the tumour may become painful. Because of the bacterial colonisation, it could lead to deep soft tissue infections. Malignant transformation is possible. Surgical removal is the treatment of choice.

Acanthosis Nigricans - A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies!

BACKGROUND: Acanthosis nigricans (AN) is acquired hyperpigmentation of the intertriginous body regions. Histologically, AN is characterised by a thickened stratum corneum and a variable amount of acanthosis. Although benign and rarely symptomatic, AN may be a red flag for underlying pathologies. CASE PRESENTATION: We analysed our patients with AN and could differentiate three different patterns, that are illustrated by one case report each. The is the benign AN associated with metabolic syndrome including obesity. The second type is the paraneoplastic AN malignancy which is associated with a wider range of malignancies. This type may occur before, after or with the clinical appearance of the malignancy. The third type is relapsing AN after complete remission. We present a patient who had a malignant AN and was treated successfully for his cancer. Years later, however, AN relapsed. In that case in association with the appearance of skin tags. Cancer restaging excluded a tumour relapse. His BMI was 31.2 kg/m2, and the diagnosis of benign AN was confirmed. CONCLUSIONS: The diagnosis of AN remains incomplete without screening for metabolic syndrome and/ or cancer. The combination of AN and skin tags is more often associated with metabolic syndrome. AN may be considered as a red flag for malignancies and the metabolic syndrome.

High-Risk Basal Cell Carcinomas of the Head and Neck: Selected Successful Surgical Approach in Three Bulgarian Patients!

BACKGROUND: Regarding localisation, basal cell carcinomas are classified in three risk groups, designated as H for high-, M as medium-, and L as low-risk area. In patients with high-risk basal cell carcinomas (BCCs), as a first-line of treatment are mentioned, different types of surgical approaches and radiotherapy. Depending on the location of the tumour, the choice of surgical technique should vary and be consistent with the patient's will for a most aesthetically acceptable result. CASE REPORT: Three cases of patients with BCCs defined as high-risk about two different indicators-localisation and relapse after radiation therapy are presented. For the recovery of the occurred defects, three different types of surgical approaches (primary closure/undermining surgical approach, island flap and advancement flap) were used, tailored to the high-risk factors in each patient, which at the same time provided a perfect clinical outcome. CONCLUSIONS: High-risk BCCs are a challenge for every dermatosurgeon and require serious training and knowledge both in terms of anatomy and in terms of the possibilities for reconstruction of the defects that occurred. Operations usually run in three phases, namely: 1) removal of tumour tissue, 2) intraoperative plan for reconstruction according to the size of the defect and the condition of the surrounding tissues as well as phase 3) undermining of surrounding tissues and adaptation of the wound edges.

Multiple Epidermal Cysts of the Scalp: Dermatosurgical Approach with Favourable Outcome!

BACKGROUND: Epidermal cysts are subcutaneous tissue formations that are most commonly located in the area of scalp, trunk and face. In addition to single ones, the cysts may also be multiple, located near each other. Although they are considered to be a cystic ectasia of the hair infundibulum and mainly affect hairy parts, they can also be seen in the area of palms and feet as a result of trauma. Rare extracutaneous localisations are also described in the medical literature, affecting the oral cavity, intraosseous, cerebrum and sublingual epidermoid cyst. Although the majority of epidermal cysts are benign, a malignant transformation may also occur in the direction of development of squamous cell carcinoma, basal cell carcinoma or Merkel cell carcinoma. Clinically, they are presented as benign lesions, and only histological examination may reveal their malignant potential. Therefore, their surgical removal and subsequent histology are of paramount importance for the elucidation of their origin. CASE PRESENTATION: An 88-year old patient was hospitalized for surgical removal of two tumorous formations in the head area which have been available for many years. During the dermatological examination in the frontal and parietal area of the head, the presence of two oval pink cystic neoplasms, clinically suspected for epidermal cysts, was found. The lesion located in the frontal area was removed by elliptical excision. The resulting surgical defect was closed by undermining the wound edges and mobilisation of the released skin to the middle of the defect, as the latter being closed by single interrupted sutures. In the second surgical session, the lesion located in the parietal region of the head was also removed under local anaesthesia. A so-called island flap was performed in which the tumour formation was removed by oval excision followed by contouring a triangle in the distal direction and transposition of the undermined triangle to the oval surgical defect. The resulting defect was recovered by single interrupted sutures. CONCLUSION: First-line treatment of epidermal cysts is surgical excision, and it is important to remove the cyst wall to minimise the risk of relapses and recurrence. Other treatment options include laser therapy with CO2, erbium-YAG laser or intralesional drainage injection of triamcinolone acetonide.

Giant Pelvic Neurofibroma in Patient with Plexiform Sciatic Neurofibroma and Neurofibromatosis Type 1.

BACKGROUND: Neurofibromatosis is a genetic disease with an autosomal dominant type of inheritance. It is a multisystem disease in which, besides skin manifestations, there is a possibility for the involvement of other organs and systems, and an atypical variant of neurofibromatosis type 1 can also be observed- the so-called plexiform neurofibroma. In patients with this inherited disease, mortality is higher due to the existing risk for malignant transformation and development of malignant peripheral nerve sheath tumours (MPNSTs) or neurofibrosarcoma. CASE REPORT: We present a 25-year-old woman with neurofibromatosis type 1 and a family history of the disease-father and grandmother with NF-1, with fatal outcome in the grandmother as a result of malignant transformation to neurofibrosarcoma. The patient has clinical data for multiple cafés- au- lait spots on the skin of the trunk, upper and lower limbs, and plexiform tumour formation in the seating area. From the performed imaging diagnostic there are available MRT data for 1) giant pelvic neurofibroma, 2) plexiform giant neurofibroma in the subcutaneous fat on the right thigh and gluteal fat tissue to the right, passing through the midline in the area of the external genitalia, leading to deformation of the front wall of the sacrum with bilateral meningoceles and 3) diffuse involvement of the bladder wall from the process in the area of the trigonum vesicae felleae/the two urethral ostium, as well as 4) the presence of neurofibromas in the course of the iliac vessels on the right. Surgical removal of the oval pelvic formation, identified as neurofibroma was planned, as well as the initiation of systemic therapy with Sirolimus for the plexiform sciatic formation, infiltrating the bladder. CONCLUSION: Neurofibromatosis type-1 is a problematic disease due to the parallel systemic involvement of different organs and systems, which can be both limited and diffuse. Limited tumour lesions in the form of neurofibromas with diverse localisation (as in the patient we describe) could be surgically removed without difficulty. On the other hand, the diffuse involvement of internal organs within a giant, network-3spreading plexiform neurofibromas (as in the described patient) makes interdisciplinary interventions impossible, and therefore therapeutic alternatives should be considered.

Scleromyxedema (Arndt - Gottron Syndrome) Developing Under Tenofovir Treatment for Hepatitis B: Unique Presentation in a Bulgarian Patient!

BACKGROUND: Scleromyxedema, also referred to as the Arndt-Gottron (S-AG) syndrome or the systemic form of Lichen myxedematosus (LM), is a cutaneous mucinosis with a chronic course and high lethality from systemic involvement of other organs and systems. Interesting in several aspects is the association between scleromyxedema and viral hepatitis about: 1) hepatitis virus infection as a possible etiological factor for the development of scleromyxedema, 2) antiretroviral therapy for the treatment of hepatitis as a method of reversing scleromyxedema and 3) antiviral drugs as inducers of scleromyxedema. CASE REPORT: We present a 53-year old patient who for nine months had been on tenofovir disoproxil 245 mg (0-0-1) therapy for chronic hepatitis B. Three months after the start of antiviral therapy (i.e. for a period of 6 months), the patient observed swelling, itching and hardening of the skin on the face, ears and hands, which subsequently spread throughout the trunk. Subsequent histological study of a skin biopsy revealed changes of scleromyxedema at an advanced stage, though immunoelectrophoresis of serum and urine excluded the presence of paraproteinaemia or para proteinuria. Systemic antihistamine and topical corticosteroid therapy were instituted. Bone involvement with possible plasmacytoma was excluded, and a myelogram showed evidence of an erythroblastic reaction of bone marrow. CONCLUSION: We believe that drug-induced scleromyxedema is a rare but possible phenomenon. We describe the first case of tenofovir-induced scleromyxedema within the framework of chronic hepatitis B treatment.

Primary Regressive, But Metastasizing Melanoma!?

BACKGROUND: Cases of regressive melanomas represent a diagnostic and therapeutic challenge because time intervals between the presence of the primary tumour formation, the metastasis and the involution of the primary tumour may intertwine or occur at different times. The regression of cutaneous melanomas does not necessarily guarantee prevention from the development of locoregional or distant metastases. There are cases in which the prognosis of patients with the development of subsequent metastasis within regressive melanomas may be better depending on the number and location of metastases. CASE REPORT: We are presenting a 42-year-old patient with two timed removals of enlarged inguinal lymph nodes within one year, as the subsequent histological examination identified histopathological data for metastasis of melanoma. BRAF testing was positive for BRAF mutation. Within the anamnesis, it was further clear that the patient had an irritated melanocytic lesion in the lateral right thigh area, which over the time disappeared and shortly after that, the enlargement of locoregional lymph nodes has been noted. CONCLUSION: In the presented case prognosis and therapeutic options for treatment of patients with regression melanomas and subsequent development of lymph node metastasis have been discussed. Currently, there is no consentaneous opinion on the applicability of the early adjuvant therapy with targeted therapies or immunotherapy in patients with regressive and non-regressive type melanomas. We suggest and share the idea that early adjuvant therapy may be beneficial generally in patients with stage III melanomas.

Hidradenitis Suppurativa (Hurley I/II): Serial Excisions with Primary Wound Closure Under Local Anesthesia As Most Adequate Treatment Approach.

BACKGROUND: Acne inversa as a chronic inflammatory disorder can be divided into three stages according to Hurley's classification. It affects the axillary and anogenital region predominantly, and its chronic course of development is associated with a major negative impact on quality of life, especially in young patients. We discuss the different types of treatment in patients with acne inversa and the benefits of two-stage surgical treatment by serial excisions with primary wound closure under local anaesthesia. CASE REPORT: We present a 28-year-old man with hidradenitis suppurativa stage I in the right axillary region and also in the pubic area. The patient is an active smoker. The patient was treated with Rifampicin 2x 300mg / day without any particular effect and preoperatively, systemic therapy with Clindamycin 4x 600mg / day was performed, combined with daily dressings with jodasept ointment for 7 days. The patient was treated through two surgical sessions under local anaesthesia with elliptical excision of the lesions located in the right axillary and the pubic area. Both of the two surgical defects were initially closed with single interrupted sutures. Histological examination of both lesions revealed the presence of suppurative folliculitis. CONCLUSION: The literature describes various methods for treating acne inversa which include both systemic and local approaches. However, it is considered that drug therapy achieves only a temporary improvement in patients with hidradenitis suppurativa. For this reason, the surgical treatment of acne inversa is indicated as the only curative treatment, especially for recurrent lesions and serial excisions under local anaesthesia, followed by primary wound closure is a valuable treatment for patients with mild to moderate HS (Hurly stage I & II).

The One Step Melanoma Surgery (OSMS): A New Chance for More Adequate Surgical Treatment of Melanoma Patients!?

One step melanoma surgery (OSMS) is applicable to all patients with clear clinical and dermatoscopic criteria for thin cutaneous melanomas or melanoma in situ lesions, even without the need for preoperative tumour thickness measurement. Amelanotic melanomas and melanomas with clinical and dermatoscopical features for regression zones could be problematic when applying the OSMS. The methodology could be also applicable to all groups of patients where the tumour thickness could be measured preoperatively/by ultrasound (while in parallel also determining the status of the locoregional lymph nodes). For tumours with a tumour thickness between 2 and 4 mm, but also over 4mm the OSMS seems to be the correct choice.

Cutaneous Tumour of the Left Cricothyroid Area!?

BACKGROUND: The cricothyroid area is an atypical localisation for placement of basal cell carcinomas. The main differential diagnosis for cutaneous tumours in this area is between BCC, spinocellular carcinoma and melanoma. The area is problematic about the choice of therapeutic approach, especially in the case of a vague clinical tumour type accompanied by enlarged lymph nodes in the immediate proximity. CASE REPORT: We present an 84- year- old woman with a tumour formation located next to the left cricothyroid area. The lymph node ultrasonography performed during the hospitalisation revealed the presence of an enlarged lymph node in the upper third of m. Sternocleidomastoideus. The initial ultrasound data of the lymph nodes were in the direction of an inflammatory rather than a metastatic process. Therefore 5 days of therapy with Ceftriaxone x 2 g/day was conducted. The nodular tumour formation was surgically removed by radical elliptic excision. The subsequent histological study found that it was Stage II basal cell carcinoma (T2N0M0). A surgeon's consultation was conducted due to a patient's complaint about abdominal pain, and clinical evidence of a hernia inguinalis incarcerata was established for which the patient was urgently transferred to a surgical ward. Two weeks after the antibiotic treatment, a control echography of the enlarged lymph node in the area of m. Sternocleidomastoideus was performed, which showed complete involution of the lymph node. CONCLUSION: Due to the specific anatomical features of the neck, such as a large number of lymph nodes and the resulting proximity between them and the primary tumours located in the area, it is often difficult to determine whether the lymph nodes are metastatically affected or inflammatory enlarged. In cases of missing ultrasound data for the metastatic process in the lymph nodes, surgical excision of the skin tumour with regular follow-up echographic control of the relevant lymph nodes represents an optimal therapeutic solution.

Drug-Induced Melanoma: Irbesartan Induced Cutaneous Melanoma! First Description in the World Literature!

BACKGROUND: Melanoma appears to be a malignant disease, whose development can be potentiated by different drug groups. More and more data are in favour of the claim that commonly used antihypertensive drugs also contain the risk of developing melanoma. The most evidence is that angiotensin receptor blockers may be carcinogenic. Two representatives from this group, valsartan and irbesartan, produced by certain pharmaceutical companies are being withdrawn from the market due to finding content of NDMA and NDEA, which are believed to be potent carcinogens. Another representative of this group, losartan, according to in vitro data, potentiates cell adhesion and invasion of human melanoma cells. CASE REPORT: We present a 45-year-old man with arterial hypertension. For year and a half/two years, the patient is on systemic therapy with Aspirin and Irbesartan/Hydrochlorothiazide. The patient also reported about the presence of a pigmented lesion in the abdominal area, which occurred 5-6 years ago, before the onset of cardiac therapy. According to him, there was a change in the colour and size of the lesion within the framework of cardiac therapy (from 1.5-2 years). Innovative one step melanoma surgery was performed, and the lesion was radically removed with a 1 cm operational safety margin in all directions within one operative session. The subsequent histological verification found the presence of thin melanoma. CONCLUSION: Drug-induced melanoma turned out to be a problem of significant importance. The group of angiotensin receptor blockers should be investigated more thoroughly and in detail on the probability of potentiating carcinogenesis. We describe an interesting case showing the progression of pigment lesion to melanoma as a possible result of irbesartan therapy, i.e. we share a theory that differs from that of drug-induced de novo melanomas. It should not be overlooked the fact that another widely used drug-Aspirin, is also likely to potentiate the development of melanoma. Furthermore, the case is indicative of the use of one step melanoma surgery in a melanoma patient with a thickness less than 1 mm.

Irbesartan Induced Cutaneous Melanoma! Second Case in the Medical Literature!

BACKGROUND: Drug-induced melanoma is a topic, concept or "reality" becoming more and more popular as the list of drugs considered as potential inducers of cutaneous melanoma is constantly growing. Interesting and current at the moment is the question/dilemma of "Irbesartan induced melanomas" and "Valsartan induced melanomas"! The following questions are without answers: 1) the general risk which angiotensin receptor blockers contain for potentiating the carcinogenesis and cancer development (as a whole); 2) available officialized data for withdrawal from the market of products with valsartan and irbesartan due to detected potential carcinogens-NDMA/NDEA, and 3) the missing official information on the most likely forms of cancer potentiated by these drugs. That is precisely why many questions remain open, and the inevitable assumption arises for the key, although according to some conspiratorial role of so-called "pharmaceutical giants" in the concept of drug-induced malignancies. CASE REPORT: We present a 72-year-old man with arterial hypertension in connection with which he is taking Irbesartan 300 mg (1-0-0), Amlodipine 5 mg (0-0-1) and Moxonidine 0.2 mg (0-0-1). The patient reported the presence of pigment lesion in the head area, which dates from many years and 3 years ago it was at the size of the nail plate on the index finger. Irbesartan therapy dates from 1.5-2 years, and according to the patient 1.5-2 years after the start of irbesartan therapy, the lesion grew sixfold, accompanied by sensitivity and discomfort in the area. Clinically and dermatoscopically the lesion had data on superficial spreading cutaneous melanoma. Tumour thickness ≤ 1 mm was measured preoperatively by ultrasound. The so-called one-step melanoma surgery (OSMS) was performed, and the lesion was removed by elliptical excision with an operative surgical margin of 1 cm in all directions within one operative session. The subsequent histological study (and screening staging) found that it was a superficial spreading melanoma stage IA (T1bN0M0). CONCLUSION: Possible, but unlikely, in our opinion, is that the intake of angiotensin receptor blockers (in particular irbesartan), and the progression of benign precursor lesions to malignant do not have a direct relationship. The growing number of data in the literature for drug-induced melanoma and massive withdrawal of products with valsartan and irbesartan due to the content of probable carcinogens speaks, however in favour of the opposite, namely that it is more likely to speak about established dependence than of a sporadic association. Drug-induced melanoma-rather a reality than a myth.

High-Risk BCC Of the Lower Eyelid in Patient with Presternal Located Cutaneous Melanoma and BCC Of the Shoulder: Melolabial Advancement Flap Combined with Undermining Surgical Approach As Promising Complex One Step Treatment Option!

BACKGROUND: It is assumed that the occurrence of keratinocyte and melanocytic tumours is multifactorial driven. Certain risk factors such as solar radiation, p53 protein and Melanocortin-1 receptor (MC1R) prove to be common to their development, which at the same time shows that their simultaneous manifestation in the same patients, for example, is quite possible. Such a manifestation could be observed as collision tumours within the same solitary lesion or as a simultaneous occurrence within two completely different lesions that are clearly distinguished from one another. CASE REPORT: An 85-year-old patient is presented with three primary cutaneous tumours located in region presternal, infraorbital sinistra and scapularis extra. The lesions were removed during a single surgical session. For the high-risk basal cell carcinoma (BCC) in the lower eyelid, the so-called melolabial advancement flap was applied, and for the tumours located in the other two areas, the undermining surgical approach was applied. The subsequent histological analysis found that the case referred to two keratinocyte tumours (BCC) and one melanocyte tumour (cutaneous melanoma). CONCLUSIONS: The patient presented is interesting with regard to 1) the simultaneous presentation of three primaries with different localization (so far not described in the world literature, namely 2 basal cell carcinomas and one melanoma in the same patient concurrently), 2) one of the basal cell tumours belongs to the group of high-risk (according to the localization) and meanwhile advanced BCC (according to the infiltration degree of the underlying tissue-infiltration of the musculature) and 3) their simultaneous successful surgical treatment in a single surgical session under local anaesthesia.