Sister Mary Joseph nodule.

Sister Mary Joseph nodule (SMJN) is a rare clinical finding in patients with metastatic adenocarcinoma. This is a case report of a 69-year-old man, who presented with a cutaneous element by his umbilicus at his GP. He was referred to a dermatologist, then a plastic surgeon. The element was a metastasis from adenocarcinoma originating from his caecum. It is important for doctors to know of SMJN as a rare presentation of metastatic cancer, and to clinically examine the patient for an abdominal starting point, when presented with a cutaneous tumour at the position of the umbilicus.

Late onset of vitiligo as first sign of dissemination of mole cancer.

Vitiligo is an autoimmune disease of the skin characterized by melanocyte loss resulting in white patches, but there is also a well-known association of vitiligo-like depigmentation and melanoma. This is a case report of a 67-year-old male with late onset of vitiligo, with a history of melanoma, who was referred to a plastic surgery department 3,5 years after the onset of vitiligo and was now diagnosed with disseminated malignant melanoma. The aim of this study is to raise awareness that onset of vitiligo, especially in patients with higher age and previously melanoma history, could represent undiagnosed primary or recurrent melanoma.

Conservatively treated wound for four months turned out to be highly malignant cutaneous angiosarcoma.

Angiosarcomas are rare, highly malignant tumours of vascular origin. They present as fast growing, haematoma-like and diffuse lesions. In this case report, a 71-year-old woman presented with what was assessed as an abscess arising from a traumatic haematoma of the forehead. The lesion was primarily treated conservatively. The condition progressed despite of treatment to a point where the tumour covered a third of her face. After four months, skin biopsies were taken and the diagnosis angiosarcoma was made. This case report should lead to an increased focus on angiosarcomas and the importance of sufficient biopsies.

[Metastatic basal cell carcinoma].

Basal cell carcinoma (BCC) is the most common diagnosed skin cancer. It often has a benign course, and metastatic BCC is extremely rare with an incidence of 0,0028-0,55%. It spreads by lymphatic and haematogenous routes, primarily to lymph nodes and lungs. The more aggressive histological types as infiltrating and morphea form is more likely to undergo metastasis. This is a case report of a patient with a primary neglected BCC on the trunk. The BCC underwent metastasis to the axillary lymph nodes. Radical axillary lymph node dissection was performed, and no further treatment was initiated.

[Chronic pain in neck, shoulder and arm disappeared after removal of lipoma over scapula].

Pain is a frequent reason for patients to see their general practitioner, and failure to provide sufficient treatment is unsatisfying for both doctor and patient. In this case report, we describe how a 51-year-old woman who had an eight-year history of pain in the neck, left arm and shoulder and had tried several types of conservative treatment, became pain free after removal of an intramuscular lipoma in m. trapezius. Intramuscular lipomas are seldom the culprit of chronic pain, but we want to remind the reader that occasionally, the answer to a complex problem can be a simple lipoma.

[Sarcoma with intracranial component misdiagnosed as subcutaneous lipoma].

We present a case story of a sarcoma, misdiagnosed as a subcutaneous lipoma, with an intracranial component. The patient developed a painless tumour less than 5 cm in diameter within a few months. An attempt of removing the tumour in local anaesthetic was stopped during the procedure as the intracranial component became evident. At a later stage, the sarcoma was removed surgically with wide local excision, local flap reconstruction and postoperative proton therapy. Six months later, the patient was well, with no clinical signs or evidence on imaging of recurrence of the sarcoma.

[Ileostomy carcinoma as a rare cause of peristomal reddening].

Ileostomy carcinoma is a rare malignant disease, which is seen primarily among patients, who have colectomy because of inflammatory bowel disease. The condition may develop decades after creation of an ileostomy and presents with reddening of the skin and adhesive problems with the stoma bag. These symptoms are easily confused with those of benign peristomal dermatoses. This is a case report of an 81-year-old woman with ileostomy because of colitis ulcerosa, where biopsies of the skin revealed ileostomy carcinoma. The patient underwent surgery, and the carcinoma was radically excised.

[Treatmentof rhinophyma with laser and surgery].

Rhinophyma is a disfiguring skin condition characterised by progressive hyperplasia of the nasal sebaceous glands and proliferation of blood vessels and connective tissue. It is considered the end stage of rosacea and affects primarily older males of Northern European descent. Several surgical and laser treatment options are available. None of these has been compared in randomised, controlled prospective trials. In this review, we provide an overview of the different treatment modalities and account for their respective strengths and limitations.