The 1 mm rule for circumferential resection margin (CRM) involvement in rectal cancer is deeply embedded in international practice, defining R1 resection as tumour at or within 1 mm of the resection margin. While this threshold has strong evidence in major resections for primary rectal cancer, its universal application is increasingly questioned. Advances in imaging, surgical technique and pathological understanding suggest that R1 status may require context-specific interpretation across three distinct clinical settings: encapsulated nodal involvement in locally advanced rectal cancer (LARC), locally recurrent rectal cancer (LRRC) and locally excised early rectal cancer (LERC). This opinion article reviews current literature, international datasets and emerging evidence to challenge the uniformity of the 1 mm definition. It draws upon The International Collaboration on Cancer Reporting (ICCR) dataset, Royal College of Pathologists (RCPath) guidance and recent large cohort and registry analyses to explore the biological and clinical relevance of close margins in these scenarios. Evidence indicates that the prognostic value of the 1 mm rule varies by anatomical and pathological context. In LARC, a lymph node metastasis abutting the CRM without extracapsular extension behaves biologically as R0 and should not be upstaged. For LRRC, narrow but clear margins (>0 mm) confer equivalent outcomes to wider margins, supporting the use of a 0 mm R1 definition. In LERC, a ≤1 mm margin may be oncologically acceptable in the absence of high-risk histological features. The current evidence supports a tailored approach to R1 definition, preserving rigour while aligning classification with modern oncological, anatomical and pathological realities.

The role of plastic reconstructive surgery in surgical reconstruction of soft tissue defects after resection of musculoskeletal tumors.

Pilomatricoma, a benign neoplasm originating from the hair follicle, typically occurs in the head and neck region. However, its occurrence in the leg is rare. We present a case of a young patient with a palpable mass on the leg. Physical examination revealed a 2 cm firm, non-tender subcutaneous nodule. Imaging studies (ultrasound and MRI) confirmed the diagnosis of pilomatricoma. The patient underwent successful surgical excision under general anesthesia, achieving clear margins. Histopathological examination demonstrated characteristic features, including basaloid cells, ghost cells, and calcifications, with no evidence of malignancy. Regular follow-up visits showed no recurrence several months postoperatively. Pilomatricoma is typically found in the head and neck region, making its occurrence in the leg extremely rare. Differential diagnosis includes lipomas, dermoid cysts, and neurofibromas. Radiological imaging, particularly ultrasound, aids in preoperative diagnosis by demonstrating characteristic features. Surgical excision with clear margins is the mainstay of treatment, ensuring complete removal and reducing the risk of recurrence. We report a rare case of pilomatricoma of the leg, highlighting the importance of considering this diagnosis even in uncommon anatomical locations. Surgical excision with clear margins resulted in successful management without recurrence. Awareness of atypical presentations of pilomatricoma is crucial for accurate diagnosis and appropriate management in clinical practice.

Tongue reconstruction is a complex surgical procedure that may require intricate microvascular surgery that increases morbidity rate and length of hospital stay. The use of new materials to enable easier procedures is currently a vast focus of research. We report the feasibility of use of a novel Polylactide Membrane (PLM) to reconstruct post-oncologic lateral tongue defects. Patients included in the trial presented to the outpatient ENT clinic complaining of lesions/tumours of the lateral tongue requiring resection and reconstruction. After resection, the PLM was fixed onto the defect bed and sutured in place using resorbable sutures. The patients were hospitalized for an average of 5 days with assessment of healing (photographs were taken), pain scores and need for analgesia and assessment of tongue function by video recording of movement and reading of a standard German text. A total of 7 patients were included in this report with no complications noted postoperatively. All cases were fully oralised by day 2 postoperatively and by day 5 speech was classified comprehensible. Patients reported low pain levels postoperatively and no bleeding episodes were noted. in cases where non- sano resection was identified (3 of our cases); a 2nd surgery was performed and clear margins were confirmes before the PLM was placed in the same manner. The use of PLM may be a promising alternative to tongue and mucosal reconstruction. The resorption of the membrane starts on day 2 postoperatively allowing for the granulation of the underlying defect bed while the PolyLactide residue continues to enhance healing and reduce pain.

Background National studies on primary malignant tumours arising from the external auditory canal (EAC) are rare. Objectives To investigate the incidence and outcomes of squamous cell carcinoma of the external auditory canal (SCC-EAC) in Sweden. Materials and methods The retrospective study included patients diagnosed with SCC-EAC in Sweden from 2007 to 2017. Results Forty-six patients with SCC-EAC were identified. The crude annual incidence was 0.043 per 100,000 inhabitants (age-standardised rate (ASR): 0.024 WHO, 0.045 Europe). Among the 40 patients treated with curative intent, 85% achieved remission, and 23% subsequently relapsed. Uncertain or non-radical primary surgery significantly correlated with residual tumour or relapse (p = 0.01) and disease-specific mortality (p = 0.002). Clear margins were achieved in 60% of T1 tumours and 21% of T4 tumours, indicating surgical undertreatment. None of the patients who underwent radical surgery died of SCC-EAC. Conclusions and significance The incidence of SCC-EAC in Sweden was lower than international rates. Non-radical surgery drastically increased mortality, and postoperative radiotherapy (PORT) could not fully compensate for incomplete resection. Consequently, a more aggressive surgical approach is justified.

Background: Parotid cancers are a diverse histological group of cancers involving the parotid gland with varying effects of prognostic factors on treatment outcomes. The effect of adjuvant radiotherapy on the outcome in parotid cancers has always been debated in the past. The objective of current study was to measure the effect of prognostic factors and the survival outcomes of patients with primary parotid cancers treated with surgery and adjuvant radiotherapy. Methods: From January 2010 to December 2023, a total of 61 patients treated at Freeman Hospital, were included in the analysis. Data was collected and stratified according to age, gender, tumour staging, surgical margins, lymphovascular invasion (LVI), peri-neural invasion (PNI), extra nodal extension (ENE) and recurrence rate. All patients treated with surgery and adjuvant radiotherapy were included in the study. Patients with incomplete data, distant metastasis or those lost to follow up were excluded. The OS, DSS and RFS rates based on surgical margins, LVI, PNI and ENE were calculated. Results: The 5-year OS, DSS and RFS were 72.6%, 79.6% and 77.7%, respectively. Positive surgical margins did not influence the survival outcome in comparison to close or clear margins. Lower survival rates were noted for patients with ENE, although not reaching statistical significance. Conclusion: Though retrospective in nature, our study provides valuable information that close or involved surgical margins do not adversely affect the outcome for parotid cancers treated with surgery and adjuvant radiotherapy and that surgical re-resection might not be indicated in this patient population.

Myxofibrosarcoma (MFS) is a rare malignant soft tissue sarcoma, typically affecting elderly patients and commonly arising from the extremities. Its occurrence in older individuals with atypical locations, such as retroauricular, is uncommon. A 50-year-old female presented with a history of recurrent left huge retroauricular mass, a painless and hard mass, not mobile, not tender, attached to the skin, approximately 4*3 cm. Initial imaging suggested a benign lesion; however, histopathological results of the excised mass revealed a spindle cell neoplasm with a lot of myxoid changes that indicate High-grade Myxofibrosarcoma. Immunohistochemistry confirmed a diagnosis of high-grade MFS. The patient underwent surgical excision of the retroauricular mass with clear margins and remains under regular follow-up with no signs of recurrence to date. In this case, the diagnostic tools of MFS are mainly used in elderly patients with atypical anatomical locations. The imaging is a nonspecific tool to confirm diagnosis, and the histopathological examination is an accurate diagnostic tool for MFS. The mainstay of MFS treatment is surgical excision, and in this case, the patient received Adjuvant Radiotherapy and systemic chemotherapy therapy (doxorubicin and ifosfamide) due to high-grade or multiple recurrences, adjuvant therapy and Regular follow- up; are essential to prevent local recurrence. This case contributes to the limited data on MFS in sub-Saharan Africa, to increase awareness and reporting, and to better understand epidemiology and management strategies in this region.

Chondrosarcoma of the maxillofacial skeleton is a rare malignant tumor characterized by cartilaginous differentiation and locally invasive growth. Diagnosis is particularly challenging in low-grade tumors because histological features often overlap with those of benign chondroma. We describe a 62-year-old woman with a recurrent cartilaginous tumor of the hard palate. After previous resections in 2013 and 2022, a third recurrence was detected. MRI showed a lobulated lesion at the anterior hard palate contiguous with the nasal septum. A two-staged treatment was performed, starting with a minimal invasive access Brown class 2a maxillectomy guided by a patient-specific cutting guide. Pending histological confirmation, an obturator prosthesis was placed to seal the oroantral communication. Histopathology confirmed a low-grade chondrosarcoma with clear margins of at least 5 mm. A second-stage reconstruction was performed a year later using a posterior pedicle lateral nasal wall flap (inferior turbinate flap) and palatal rotation flap restored nasal lining and oral mucosa. This approach achieved oncologic clearance with excellent functional outcomes. The case highlights the value of image-guided maxillectomy and staged regional flap reconstruction.

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. Although it has a good prognosis, cSCC of the ear is associated with a poorer outcome. Reconstruction following total ear amputation because of a cSCC of the ear can be challenging, especially in elderly patients. Currently, to the best of our knowledge, the number of published articles discussing reconstruction modalities following total ear amputation is relatively limited. A 95-year-old patient presented with an advanced form of cSCC of the left ear. Total ear amputation and defect reconstruction using a large preauricular transposition flap was performed. Because the patient was blind, there was no need to save the helix fold or tragus as an eyewear holder. Postoperative flap viability was good and, after complete site healing, the patient and his family were satisfied with its aesthetic appearance. Histopathological analysis showed poorly differentiated cSCC penetrating the surface of the auricular cartilage, with wide clear surgical margins. Total ear amputation in cases of advanced cutaneous carcinomas is very rare and lacks reconstructive modalities. In this patient, it provided him with tumor-free status as well as a satisfactory aesthetic appearance with good quality of life.

Superficial leiomyosarcoma is a rare soft tissue sarcoma that typically presents as a firm, painful nodule in adults older than 50 years. We report a unique case of a 35-year-old woman with a slow-growing, mobile, subcutaneous nodule on the upper arm, initially presumed to be a benign lesion, most likely an angiolipoma. After excisional biopsy, histopathologic evaluation revealed an intermediate-grade leiomyosarcoma with focal dedifferentiation, demonstrating an abrupt transition from well-differentiated leiomyosarcoma to a high-grade, immunophenotypically undifferentiated sarcoma. Immunohistochemical staining showed loss of smooth muscle actin and desmin in the central dedifferentiated region, with retention of these stains at the peripheral lower-grade components. Wide local excision achieved clear margins, and imaging revealed no metastasis. Only 2 prior cases of cutaneous dedifferentiated leiomyosarcoma have been reported, both in the head and neck and with a more classic clinical presentation of a firm and immobile nodule. Our case is unusual in its location and deceptively benign clinical presentation. Given its aggressive potential and high reported rates of metastasis and mortality, prompt recognition and excisional biopsy are essential for diagnosis. This case highlights the importance of maintaining clinical suspicion for malignancy in persistent subcutaneous nodules and adds to the limited literature on dedifferentiated cutaneous leiomyosarcoma.

Pilomatrixoma is a rare benign skin neoplasm originating from the hair follicle matrix and is exceptionally uncommon in breast tissue, particularly in male patients. Due to overlapping clinical and ultrasonographic features, it is frequently misdiagnosed as breast cancer. This study aims to highlight pilomatrixoma as an important differential diagnosis of breast masses and to emphasize the role of histopathological confirmation. We report two male patients with breast lesions. A 40-year-old male presented with an infected breast lesion, and a 70-year-old male presented with a palpable breast mass. Both patients underwent clinical evaluation, ultrasonography, and tru-cut biopsy. Following histopathological confirmation of pilomatrixoma, elective surgical excision was performed. Tru-cut biopsy findings in both cases were consistent with pilomatrixoma. Ultrasonographic evaluation suggested suspicious features, leading to BI-RADS 4–5 categorization and initial concern for malignancy. Complete surgical excision with clear margins was achieved in both patients, and no complications or recurrences were observed. Pilomatrixoma is a rare benign tumor of the skin that can closely mimic breast cancer, especially on imaging. Despite its typical occurrence in the head, neck, and upper extremities and predominance in young females, it should be considered in the differential diagnosis of male breast masses. Histopathological confirmation via tru-cut biopsy is essential for accurate diagnosis, and surgical excision with clear margins is curative.

Abstract Background: Whole breast irradiation (WBI) after breast conserving surgery for ductal carcinoma in-situ (DCIS) reduces local recurrence. We aimed to evaluate whether a tumor bed boost after WBI improved long-term outcomes, and examine radiation dose fractionation sensitivity for non-low-risk DCIS. Methods: The study was an international, randomized, unmasked, phase 3 trial involving 136participating centers from six clinical trials organizations in 11 countries. Eligible patients were women aged ≥18 years who had breast conserving surgery with ≥1 mm of clear radial resection margins for unilateral, histologically proven, non-low-risk DCIS defined as age <50 years or age ≥50 years plus at least one of the risk factors for local recurrence (palpable tumor, multifocal disease, tumor size ≥1.5cm, intermediate or high nuclear grade, central necrosis, comedo histology and/or surgical margin<10 mm). Patients were stratified by age (<50 years vs ≥50 years), planned endocrine therapy (yes or no) and treating center. They were randomized to one of four groups (1:1:1:1) of no boost versus boost after conventional versus hypofractionated WBI, or to one of two groups (1:1) of no boost versus boost after each center-prespecified conventional or hypofractionated WBI. The conventional WBI was 50 Gy in 25 fractions, and hypofractionated WBI was 42·5 Gy in 16 fractions. A boost dose of 16 Gy in eight fractions, if allocated, was delivered after WBI. The primary endpoint was time to local recurrence. Secondary endpoints were time-to-disease recurrence, overall survival and treatment toxicity. Cosmetic outcome and health-related quality of life will be reported separately. This trial is registered with ClinicalTrials.gov (NCT00470236). Results: Between June 25, 2007, and June 30, 2014, 1608 patients were randomly assigned to no tumor bed boost (805 patients) or boost (803 patients). Conventional WBI was given to 831 patients, and hypofractionated WBI was given to 777 patients. Endocrine therapy was used in 13% of patients. Median follow-up was 10.2 years. The 10-year free-from-local-recurrence rates were 87% (95% CI 84-89%) in the no-boost group and 93% (91-95%) in the boost group (hazard ratio 0.49; 0.34-0.69;p<0.001). Fifty-four percent and 58% of local recurrences were invasive in the no-boost and boost groups, respectively. There were no significant differences in the 10-year free-from-local recurrence rates between the conventional WBI and hypofractionated WBI groups in the 4-arm randomization category (90% vs. 89%, P=0.82) or in all randomized patients (89% vs. 91%, P=0.80). The test for interaction between boost and dose-fractionation was not significant in the 4-arm randomization category (P=0.39) or in all randomized patients (P=0.77). The 10-year free-from-disease recurrence rates were lower in the no-boost group (79%) than in the boost group (87%; hazard ratio, 0.67;0.52−0.86; p=0.002). There was no statistically significant difference in 10-year overall survival rates between the no-boost (94%) and boost (96%) groups (0·73; 0·47-1·14; p=0·17). The boost group had higher rates of grade 2 or higher breast induration (7% [5-9%] vs 17% [14-19%], p<0.001) and breast pain (11% [9-13%] vs 17% [14-20%], p=0·002), with no suggestion of interaction with WBI dose fractionation. Conclusions: Our results provide the first long-term randomized trial data to demonstrate the efficacy of tumor bed boost radiation after postoperative WBI on local recurrence in patients with non-low-risk DCIS with an associated increase in grade 2 or greater breast induration and pain. Within the limits of the trial design, moderately hypofractionated WBI was not associated with an increase in local recurrence or toxicity. Citation Format: B. H. Chua, E. K. Link, I. A. Olivotto, I. Kunkler, T. Whelan, P. Deseyne, G. Gruber, BIG 3-07/TROG 07.01 trial investigators.. Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3-07/TROG 07.01): final 10-year analysis of a randomised, factorial, multicentre, open-label, phase 3 study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr GS2-12.

Abstract Background: Metaplastic breast cancer (MpBC) is a rare and aggressive subtype of breast cancer with limited guidance on an optimal management approach in existing clinical guidelines. We evaluated long-term outcomes and treatment efficacy in early MpBC patients across major cancer centers in Hong Kong. Methods: Women with non-metastatic MpBC diagnosed from January 2001 to December 2023 at four Hong Kong hospitals were identified via Hong Kong Cancer Registry. Clinical data, treatment response, recurrence, and survival were analyzed by histological and molecular subtype according to current standards, based on review of original pathology reports. Survival analyses were conducted using the Kaplan-Meier method and compared using log-rank test. Factors associated with survival were evaluated by univariate and multivariate Cox regression. Results: In total, 145 consecutive patients with non-metastatic MpBC were included. The median age at diagnosis was 57 years (IQR 51-68 years), with 64.8% being postmenopausal. Most patients presented with a solitary tumor (94.5%), commonly in upper outer quadrant (58.6%). Squamous cell carcinoma (20.7%) and spindle cell carcinoma (13.1%) were the most common histological subtypes. Most cases were stage II (55.2%), with a median tumor size of 3.5 cm (IQR 2.4-6.0 cm), node-negative at diagnosis (66.2%), and grade 3 tumors (66.9%). Molecular subtyping showed that 49.7% of tumors were triple-negative, 45.5% were hormone receptor-positive only (≥1% ER and/or PR-positive tumor cells), 2.8% were HER2-positive only, and 2.1% were both ER/PR-positive and HER2-positive. 4.1% of tumors were ER low, and 37.9% HER2 low. Most patients underwent mastectomy (77.2%) with axillary dissection (58.6%), and 93.8% achieved clear margins. Neoadjuvant chemotherapy was given to 13.8% of patients, with a pathological complete response (pCR) in 5.0% and a partial response in 50.0%. Adjuvant chemotherapy and radiotherapy were given to 57.2% and 60.7% of patients, respectively. At a median follow-up of 112 months (IQR 28-165), the 5-year overall survival was 67%. Five-year locoregional and distant relapse-free survival rates were 90.4% and 72.1%, respectively. Locoregional recurrence occurred in 11%, and distant metastases in 27.6% of patients, mainly involving visceral sites (90%). Upon univariate analysis followed by multivariate analysis adjusted for grade, T stage, and molecular subtype, adjuvant chemotherapy was significantly associated with improved overall survival (HR 0.42, 95% CI 0.22-0.82, p=0.01), while adjuvant radiotherapy was not (HR 0.69, 95% CI 0.38-1.24, p=0.21). In T3/4 or node-positive subgroup, adjuvant chemotherapy remained significantly associated with improved overall survival (HR 0.32, 95% CI 0.12-0.83, p=0.02), whereas adjuvant radiotherapy did not show significance for overall survival (HR 0.65, 95% CI 0.29-1.45, p=0.29) or for locoregional relapse-free survival (HR 0.98, 95% CI 0.40-2.40, p=0.96). No significant differences in pCR rates following neoadjuvant chemotherapy were observed across molecular subtypes (p=0.67). Adjuvant endocrine therapy was not associated with overall survival in hormone receptor-positive cases (p=0.88), nor was targeted therapy in HER2-positive cases (p=0.47). Conclusion: This study showed that MpBC is a distinct subtype of breast cancer, characterized by unique clinicopathological characteristics and responsiveness to treatments. Adjuvant chemotherapy was associated with improved overall survival in non-metastatic MpBC, while adjuvant radiotherapy did not demonstrate a significant benefit. The low response rate to neoadjuvant chemotherapy highlights the urgent need to develop novel therapeutic strategies to enhance outcomes for this challenging patient population. Citation Format: S. S. Tse, K. Bao, K. Cheung, J. Chow, I. Wong, C. Wong, O. Mang, H. Yiu, C. Kwan. Long-term outcomes and prognostic factors in metaplastic breast cancer treated with curative intent: a 22-year multicenter retrospective cohort study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-08-09.

Abstract Background: While there are abundant data on the surgical management of BC after neoadjuvant chemotherapy (NAC), there is less guidance regarding surgical management of BC after NET, particularly with respect to lymph node (LN) surgery. While pathologic complete response (pCR) is common with NAC, it is a rare event with NET. In this analysis we assess the surgeons’ approach in the context of NET. Methods: The ALTERNATE trial is a phase III study that randomized postmenopausal patients (pts) with clinical stage II/III ER+ HER2- BC to receive neoadjuvant anastrozole (A), fulvestrant (F), or both for 6 mos. before surgery. The primary objective was to determine if neoadjuvant F or A+F increases the rate of pCR or ypT1-2N0/N1mic/Ki67 <2.7% residual disease over A alone. Breast surgery was per standard of care. Sentinel lymph node biopsy (SLNB) with or without axillary lymph node dissection (ALND) was required to determine preoperative endocrine prognostic index PEPI score and residual cancer burden (RCB). Surgeons were required to indicate if the patient would be eligible for breast- conserving surgery (BCS) prior to NET. Patient accrual occurred from 2014-2018. The surgical outcomes are reported for the entire group. Results: Among the 3 treatment arms, 933 patients completed 6 cycles of NET. The clinical T stage at diagnosis was 73.6% T2, 22.6% T3and 3.8% T4. Initial tumor size was assessed by mammogram and ultrasound. Primary tumor histology was ductal in 64.8% and lobular in 25.4%.568 pts (60.9%) were clinically node negative (cN0), 36.2% cN1, 2.6% cN2 with 0.3% cN3. LNs were palpable in 25.2%. 383 had LN needle biopsy pre NET, of which 80.9% were positive. The surgeons’ initial impression of the patient’s eligibility for BCS was 74% while 0.6% were considered inoperable.75.5% of pts had post-NET imaging performed. Of those with tumor size recorded, 52.9% were T1 or not visible. Overall, 69.9% of the 933 patients had BCS. Of those 330 pts without post-NET imaging or who had post-NET imaging without a size noted, 64.8% underwent BCS. For pts undergoing BCS, 80.2% required only one surgery for margin clearance. Of the 690 pts deemed eligible for BCS pre NET, 79% had BCS. Of the 240 pts deemed ineligible for BCS pre-NET, 43.8% had BCS. Of the pre-NET cT2 tumors, 79% had BCS while only 45.5% of T3 tumors and 37.1% of T4 tumors had BCS. On surgical pathology, 474 (50.8%) pts were LN+ compared to pre-NET cN+ 39.1% and needle biopsy-proven 33.2%. For pts with pN0, 93.3% had SLNB alone. 6.7 % of pN0 had ALND alone or SLNB+ALND. For those with pN1-3 , 36.3% had SLN only; 37.3% SLN+ ALND; 26.4% ALND alone. Only 0.8% of the patients had no ALND or SLNB performed. Pts undergoing BCS were more likely to have SLNB alone for a +SLN compared to mastectomy pts (62.9% vs. 37.6%; chi-square p<0.0001). For pts with pre-NET +LN on needle biopsy, only 26.8% underwent SLNB alone, while 37.4% underwent ALND alone. Of the 204 LN-positive pts having SLNB alone, 55.9% had only 1 + LN and 27% had only 2+ LNs. For pN+ pts who underwent SLNB +ALND, 42.1% had 1-2 + LNs. Conclusion: With NET, 69.9% of pts achieved BCS, including 43.8% deemed ineligible pre-NET. Given the low rate of pCR to NET, there should not be the expectation of pCR in +LNs. Based on the procedures performed in pts with +SLNs, it appears that surgeons were applying ACOSOG Z0011 criteria for pts having BCS, but were less likely to omit ALND for +LN in pts having mastectomy. The finding of only 1-2 +LNs in many of the LN+ pts suggests that omission of ALND may be a reasonable approach post-NET. Longer follow-up is required to assess local-regional recurrence. Support: U10CA180821, U10CA180882; https://acknowledgments.alliancefound.org. Clinical Trials.gov Identifier: NCT01953588 Citation Format: A. M. Leitch, T. Dockter, V. suman, A. Weiss, G. W. Unzeitig, J. Guenther, S. Sanati, K. Vij, J. Hoog, A. Caudle, A. Tiersten, M. Mita, W. Razaq, T. J. Hieken, Y. Wang, M. Rimawi, M. J. Ellis, E. Winer, K. K. Hunt, A. H. Partridge, L. A. Carey. Surgical outcomes in the ALTERNATE trial (Alliance A011106) -a randomized phase 3 neoadjuvant endocrine therapy (NET) trial in postmenopausal women with clinical stage II/III estrogen receptor positive (ER+) and HER2 negative (HER2-) breast cancer (BC) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr RF1-02.

Abstract Background: Breast conserving surgery for locally advanced breast cancer remains a controversial approach,Historically mastectomy has been the preferred surgical intervention for patients with T3/T4 breast cancer. However,the utilization of neoadjuvant systemic therapy (NAST), development of oncoplastic breast conserving techniques rendered BCS an increasingly appealing option for patients and surgeons. Methodology: Study aims to evaluate the surgical and oncological safety of BCS for non-inflammatory, non-multicentric T3/T4 non-metastatic breast cancer through a retrospective analysis of prospectively maintained data. 75 female patients diagnosed between 2017 and 2024. Analysis encompassed clinico-pathological characteristics, treatment modalities and surgical outcomes, including surgical margins, rates of margin re-excision and conversion to mastectomy and pathologic complete response (PCR) or down-staging to a lower tumor stage after NAST. Oncological outcomes included disease recurrence and overall survival. Result: Out of 75 patients, 43 (57%) had T3 lesion,32 (43%) had a T4a-c lesion. Mean age of patients was 52 years. Most of patients had an invasive ductal histology (95%) of high grade (71%), node positive (60%). Luminal type comprised 41%,37% triple negative and 21% were HER2neu positive. BCS associated with positive surgical margins in 2 patients (2.6%) one underwent margin re-excision (1.3%), other patient (1.3%) converted to mastectomy for margin clearance. Most of the patients received NAST; 63 (84%) chemotherapy, 6 (8%) hormonal therapy. Majority (93%) received adjuvant radiotherapy. PCR observed in 31(45%) patients,35 (50%) achieved down-staging to smaller tumor size, including patients with triple negative or HER2 positive. 3 patients (5%) with luminal type failed to achieve pathological response to NAST and had identical clinical and pathological tumor stages. On multivariate analysis, patients with TN (70%) and HER2 positive (50%) were likely to achieve PCR after NAST, compared to patients with luminal type (8%) (P<0.001). with average follow up duration of 34 months, our cohort demonstrated an overall survival rate of 95%. While the majority of patients remained disease-free, Tumor recurrence was observed in 10 (13%) patients. No isolated local recurrences. Most recurrences were systemic (11%), compared to one systemic and local, and another Locoregional recurrence (1% each). Systemic recurrences were predominantly associated with HER2 positive (50%) grade 3 (60%) and characterized by the lack of PCR (78%) after NAST. However, this did not correlate to statistical significance. Discussion: Data demonstrates that BCS for T3/T4 non inflammatory breast cancer after NAST is associated with low rates of positive surgical margins and conversion to mastectomy, while maintaining acceptable outcomes after oncoplastic surgery, including level 1 and 2, therapeutic reduction mammoplasty, and chest wall perforator flap reconstruction. Isolated local recurrence was rare, and most recurrences were systemic, suggesting that treatment failure was primarily systemic rather than regional. Interestingly, the two patients who experienced local recurrence had negative surgical margins following BCS; however, they did not receive adjuvant radiation, and both had a triple positive, the association between local recurrence and HER2-positive subtype, high tumor grade, and lack of PCR highlights the impact of tumor biology on prognosis Conclusion: BCS for non-inflammatory T3/T4 breast cancer appears to be both surgically and oncologically safe after NAST. Therefore, it should be considered and thoroughly discussed with the patient as a viable treatment alternative to mastectomy. Citation Format: L. Almaghrabi, J. Alazhri, F. Aldulaijan, N. Almana, S. Alajmi, M. Alduhaileb, A. Abbas. Is Breast Conserving Surgery a Viable Option for Non-Inflammatory T3/T4 Breast Cancer? [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-01-03.

Introduction: Ewing’s sarcoma is a rare and aggressive malignant small round-cell tumor that typically arises in the long bones and pelvis, with only 1–2% of cases involving the maxillofacial skeleton. Mandibular presentation is exceptionally uncommon and presents diagnostic and therapeutic challenges. This study reports a clinical case and includes a focused literature review. A 9-year-old girl presented with a large mandibular mass associated with airway compromise and recurrent intraoral bleeding. Clinical, radiological, and histopathological examinations were performed. The patient underwent urgent tracheostomy, near-total mandibulectomy with a lip-split incision and 2 cm margins, followed by immediate titanium plate reconstruction. Postoperative care included adjuvant multiagent chemotherapy. A literature review of cases reported between 1988 and 2025 was conducted for comparison. Surgery achieved complete tumor resection with immediate stabilization of the airway and mandibular continuity. Postoperative histopathology confirmed the diagnosis of Ewing’s sarcoma with clear margins. The patient recovered with stable airway function and initiated adjuvant chemotherapy. Review of published cases demonstrated variability in presentation, management, and survival outcomes. A summary of comparative mandibular cases is presented in Table 1. Pediatric mandibular Ewing’s sarcoma is rare but may present with airway emergencies. Early recognition, multidisciplinary planning, and prompt surgical intervention with airway protection are critical for favorable outcomes.

Cutaneous squamous cell carcinoma (cSCC) represents the second most common skin cancer and poses a significant public health challenge. Given the rising incidence of skin cancer, it is essential to address surgical management strategies and to identify factors associated with clear resection margins, recurrence, and metastasis. This study aims to analyze the frequency of tumor-free resection margins, local recurrence, and metastasis, as well as the underlying risk factors. The central research question is: Which clinical and histopathological characteristics are significantly associated with an increased risk of incomplete resection, recurrence, and metastasis? A retrospective analysis was conducted on data from 176 patients diagnosed with cSCC between 2019 and 2024. Patient data were evaluated based on clinical records, histopathological findings (including tumor thickness and depth, histological subtype, infiltration pattern, and surgical margin status), and follow-up assessments, which included routine ultrasound examinations. Tumor diameter was the only independent predictor of achieving tumor-free resection margins (R0 status). Local recurrence occurred in 11.2% of patients and was significantly associated with tumor depth, whereas tumor diameter showed no correlation with recurrence-free survival. Suspicious lymph nodes on preoperative ultrasonography were detected in 3% of patients in the neck and 5% in the parotid gland. Four patients (2.2%) with suspicious findings underwent neck dissection and/or parotidectomy; synchronous metastases were confirmed in three cases (1.7%), all in cervical nodes. Further five patients (2.8%) developed metachronous lymph node metastases and were treated with surgery and adjuvant radiotherapy. Tumor depth was identified as the main determinant for achieving complete tumor resection, underscoring its prognostic relevance in cSCC. The low incidence of synchronous and metachronous lymph node metastases highlights the favorable local control achievable with adequate surgical margins and regular follow-up. The study further emphasizes the importance of early detection and structured surveillance, including regular head and neck ultrasonography, for the timely identification of metastatic disease and optimized patient management.

Myopericytoma of the dorsum of the foot: a case report

Abstract Sebaceous carcinoma is a rare and potentially aggressive malignant adnexal tumour, most commonly occurring in the periocular region. Extraocular presentations, particularly involving the extremities, are uncommon and may pose diagnostic and management challenges due to their non-specific clinical appearance. We report the case of a 22-year-old female who presented with a chronic non-healing lesion over the medial aspect of the right big toe. The lesion had been present for 2 years with progressive enlargement. Initial excision and skin grafting were performed at an outside hospital; however, histopathology revealed positive surgical margins and the wound failed to heal. Further evaluation confirmed sebaceous carcinoma with deep margin involvement. The patient was referred to a tertiary care centre, where definitive wide local re-excision achieved clear margins. The surgical defect healed completely by secondary intention without the need for further reconstruction. This case highlights an unusual presentation of extraocular sebaceous carcinoma in a young patient and underscores the importance of early suspicion, accurate histopathological diagnosis and complete surgical excision with clear margins. Adequate oncologic management can result in favourable outcomes even in rare and atypical presentations.

Introduction and importance: Ewing sarcoma (ES) rarely arise in the toes, where nonspecific pain and swelling can mimic benign conditions, delaying diagnosis. Early recognition is critical because modern multimodal therapy can achieve limb preservation and high rates of disease control even at unconventional sites. Case presentation: A healthy 22-year-old man developed progressive pain and swelling of the left hallux after partial nail excision for a presumed ingrown toenail. The wound failed to heal, evolving into a friable 3 × 3 cm dorsal mass. Radiography and MRI demonstrated an aggressive lytic lesion destroying the distal phalanx with soft-tissue extension. Incisional biopsy revealed small round blue cells strongly positive for CD99, and fluorescence in situ hybridization confirmed an EWSR1 rearrangement consistent with ES. Staging PET-CT showed no metastases. The patient received six cycles of vincristine–doxorubicin–cyclophosphamide alternating with ifosfamide–etoposide, followed by partial amputation of the distal phalanx with clear margins. Histology showed 98% tumor necrosis. Adjuvant chemotherapy was completed uneventfully. At 12-month surveillance, MRI and PET-CT showed no local recurrence or distant spread, and the patient had painless, functional ambulation. Clinical discussion: This case highlights three key lessons: 1. Persistent or atypical digital lesions warrant oncologic evaluation. Soft-tissue masses that do not resolve after routine care should prompt advanced imaging and biopsy. 2. Molecular confirmation is pivotal. Detection of an EWSR1-FLI1 family fusion secures the diagnosis and guides therapy. 3. Neoadjuvant chemotherapy enables limb-sparing surgery. Pre-operative tumor shrinkage facilitated margin-negative resection while preserving toe function, and a 98% necrosis rate predicts favorable prognosis. Vigilant, long-term surveillance remains essential because ES can relapse late. Conclusion: Ewing sarcoma of the great toe is exceptionally rare but can be successfully treated when identified early and managed with coordinated multimodal therapy. Clinicians should maintain vigilance for malignancy in non-healing digital lesions to ensure timely intervention and durable outcomes.