Intralesional Excision Research Articles

Effectiveness of Core Excision Technique for Keloids: A Systematic Review.

The keloid core excision technique mitigates the risk of wound tension and promotes favorable morphological outcomes. However, whether residual keloid tissue or other factors increase the risk of recurrence remains unclear. This systematic review aimed to evaluate the therapeutic outcomes of core excision techniques for keloids. A systematic literature review was conducted by searching PubMed, Embase, Web of Science Core Collection, and Cochrane Library databases on July 30, 2023. The search terms employed were "keloid," "core excision," "intralesional excision," "intramarginal excision," "rind flap," and "fillet flap." The inclusion criteria for the studies were established in advance and evaluated by multiple investigators. Overall, 20 studies involving 926 keloid cases managed through core excision were included. Adjuvant therapies were used in 19 studies, with radiotherapies and steroid injections emerging as the predominant methods. The recurrence rates ranged from 0% to 28.6%. Residual scar tissue after core excision and complications, such as flap necrosis and hematoma, are the major factors contributing to recurrence. The core excision technique is a surgical treatment of keloids with a low recurrence rate when combined with adjuvant therapies. However, randomized controlled trials and conclusive quantitative studies are necessary to further investigate the effects of the core excision technique on keloids.

Advances in the multidisciplinary surgical approach to primary spinal sarcomas: insights from a retrospective case series on outcomes and survival

IntroductionThe management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices.MethodsWe conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery.ResultsThe study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery.ConclusionsOur 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.

Analysis of factors influencing the efficacy and prognosis of surgical treatment for primary malignant pelvic bone tumors

Objective: To analyze the prognostic factors and the influence of surgical margin to prognosis. Methods: A retrospective analysis was performed for 208 pelvic tumors who received surgical treatment from January 2000 to December 2017 in our instituition. Survival analysis was performed using the Kaplan-Meier method and Log rank test, and impact factor analysis was performed using Cox regression models. Results: There were 183 initial patients and 25 recurrent cases. According to Enneking staging, 110 cases were stage ⅠB and 98 cases were stage ⅡB. 19 lesions were in zone Ⅰ, 1 in zone Ⅱ, 15 in zone Ⅲ, 29 in zone Ⅰ+Ⅱ, 71 in zone Ⅱ+Ⅲ, 29 in zone Ⅰ+Ⅳ, 35 in zone Ⅰ+Ⅱ+Ⅲ, 3 in zone Ⅰ+Ⅱ+Ⅳ, and 6 in zone Ⅰ+Ⅱ+Ⅲ+Ⅳ. Surgical margins including Intralesional excision in 7 cases, contaminated margin in 21 cases, marginal resection in 67 cases, and wide resection in 113 cases. Local recurrence occurred in 37 cases (17.8%), 25 cases were performed by reoperation and 12 cases received amputation finally. The 5-year recurrence rate of marginal resection was higher than wide resection (P＜0.05), and the recurrence-free survival rate of marginal resection was lower than wide resection (P＜0.05). There was significant differences in recurrence rate and recurrence-free survival rate between R0 and R1 resection (P＜0.05). 92 cases were not reconstructed and 116 cases were reconstructed after pelvic surgery. At the last follow-up, 63 patients (30.3%) died, and the 5-year, 10-year and 15-year survival rates were 70.4%, 66.8% and 61.3%, respectively. The 5-year survival rate of stage ⅠB and ⅡB tumor was 90.4% and 46.8%, respectively. There were 29 cases had postoperative wound complications (13.8%), 1 case with pelvic organ injury. The final function was evaluated in 132 patients, with an average MSTS score of 25.1±3.6. Cox multivariate analysis showed that surgical staging, R0/R1 margin and metastasis were independent prognostic factors for pelvic tumors. Conclusions: The safe surgical margin is the key factor for recurrence-free of pelvic tumor. The survival rate of stage ⅡB pelvic tumors was significantly lower than that of stage ⅠB tumors. Wound infection is the main postoperative complication. Surgical staging, R0/R1 margin and metastasis were independent prognostic factors of pelvic tumors.

Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids.

The objective of this meta-analysis was to examine the effectiveness of keloid intralesional excision (KILE) in preventing recurrence. Treatment of keloids using surgical excision alone leads to high rates of recurrence. To date, there are no widely accepted guidelines for keloid treatment, and a multitude of adjunctive therapies are used to reduce recurrence. Despite these efforts, recurrence remains high. In this study, we conducted a meta-analysis of the existing literature on KILE to determine its role in recurrence reduction. A literature review using PubMed, Scopus, and Web of Science databases was performed. Two authors independently evaluated studies for eligibility. Incidence of keloid recurrence was recorded, and a comprehensive meta-analysis was performed to assess the pooled keloid recurrence rate, as well as the effect of additional therapies. Twenty-two studies evaluating intralesional excision of 608 keloids were included in the study. Average time to follow-up was 19.2 months (range 6-35 months). A meta-analysis of proportions was conducted, demonstrating a pooled recurrence rate of 13% (95% confidence interval, 9%-16%). There was no evidence that using therapies in addition to KILE had a significant effect on the overall pooled recurrence rate. A meta-analysis of 608 keloids shows that KILE is an effective technique in preventing keloid recurrence, with a pooled recurrence rate of 13% compared with previously reported rates of 45%-100% after complete excision. Although there are no standard guidelines for keloid treatment, our meta-analysis shows that KILE is promising in recurrence reduction.

Parecoxib decreases cellular growth and Bcl-2 protein levels in primary cultures of keloid fibroblasts.

Keloids seem to overexpress cyclo-oxygenase-2 (COX-2), suggesting a role in its deregulated pathway in inducing an altered epithelial-mesenchymal interaction, which may be responsible for the overgrowth of dermal components resulting in scars or keloid lesions. This study aimed to evaluate the effect of Parecoxib, a COX-2 inhibitor, on cell growth in fibroblast primary cultures obtained from human keloid tissues. Tissue explants were obtained from patients who underwent intralesional excision of untreated keloids; central fractions were isolated from keloid tissues and used for establishing distinct primary cultures. Appropriate aliquots of Parecoxib, a COX-2 inhibitor were diluted to obtain the concentration used in the experimental protocols in vitro (1, 10 or 100 μM). Treatment with Parecoxib (at all concentrations) caused a significant decrease in cellular growth from 24 hours onwards, and with a maximum at 72 hours (P < .02). Moreover, at 72 hours Parecoxib significantly reduced cellular vitality. Parecoxib treatment also induced an increase in fragmented nuclei with a maximum effect at 100 μM and a significant decrease in Bcl-2 and an increase in activated caspase-3 protein levels at 72 hours compared with control untreated cultures. Our findings suggest a potential use of the COX-2 inhibitor, Parecoxib, as the therapy for keloids.

Comparison of En Bloc Resection and Intralesional Excision for Re-resection of Giant Cell Tumors of the Spine.

Re-resection of spinal giant cell tumors is an exceedingly difficult procedure. Moreover, the prognosis of patients with en bloc resection or intralesional excision for re-resection has rarely been reported. This study aimed to compare the prognostic value of en bloc resection with that of intralesional excision in patients undergoing re-resection for giant cell tumors of the spine. This retrospective analysis evaluated patients who underwent revision surgeries for relapse of giant cell tumors of the spine at our center between January 2005 and January 2021. Local progression-free survival represents the duration between en bloc resection or intralesional excision and tumor recurrence. Neurological recovery, survival rates, local control, and complications were evaluated. The Kaplan-Meier estimator was used for survival analysis. A total of 22 patients (nine men and 13 women) with a mean age of 34.1 (range 19-63) years were included. Significant statistical differences were found in the local tumor recurrence rate between patients treated with en bloc resection and those treated with intralesional excision (p < 0.05). The 5- and 10-year local progression-free survival rates were both 90% in the en bloc resection group, while in the intralesional excision group, the 5-year local progression-free survival rate was 80% with a 10-year rate of 45.7%. The en bloc resection group had a lower local tumor recurrence rate than that of the intralesional excision group (p < 0.05), but the former had a higher rate of complications (p = 0.015). This study revealed a low local recurrence rate in patients who underwent en bloc resection for giant cell tumors, while the perioperative complication rate was high.

Pleomorphic Hyalinizing AngiectaticTumor: A Case Report and Literature Review

Pleomorphic hyalinizing angiectatictumor (PHAT), a rare low-grade non-metastasizing tumor, was first reported in 1996[1]. It affects patients with a mean age of 54.5 years and no predilection for gender[2], and has a preference for the subcutaneous soft tissue in the lower extremity. The main histology features are clusters of hyalinized ectatic blood vessels and scattered pleomorphic cells or spindle cells with nuclear pseudoinclusions. The clinical behavior is characterized by local recurrence in 30-50%, and no cases have been known to metastasize. A wide intralesional excision and long-term postoperative follow-up become the main therapeutic approach. So far, about 130 cases have been reported in the literature, and its manifestation on electron microscope and imaging has not yet been fully described. Here, we report a case of PHAT and describe its morphological and imaging performance.

Bone Substitutes in Management of Benign Bone Tumors, Review of Literature

Intralesional excision or curettage is commonly used to treat benign and low-grade malignant bone tumors. The resulting defect can be treated with a variety of materials, such as autologous bone grafts, allografts, or synthetic materials like polymethylmethacrylate or composite alternatives. Because it is osteogenic, osteoinductive, and osteoconductive, autologous cancellous bone is often considered the gold standard of transplant material. However, issues including transplant size limitations, wound-related complications, and prolonged donor site pain have limited its usage in clinical practice. Concerns about immunogenicity and infection have also hampered the use of demineralized freeze-dried allografts and xenografts. As a result, synthetic materials have sparked substantial interest in orthopedics, and a variety of bone graft alternatives are now commercially accessible.

Thermal necrosis in orthopedic bone tumors: experimental research.

The extent of surgical resection in orthopedic oncology differs according to tumor biology. While malignant bone tumors are operatively managed with wide resection, benign bone tumors and metastatic carcinomas are often treated through intralesional excision and adjuvant modalities, including the elimination of residual neoplastic cells through thermal necrosis. This study investigates in vitro temperature thresholds for thermal necrosis in common orthopedic bone tumors. Eleven cell lines, including metastatic carcinomas to bone (A549, A498, FU-UR-1, PC3, MDA-MB-231, TT, MCF7, and K1), giant cell tumor of bone, osteosarcoma (HG-63), and control non-neoplastic cells (HEK293) were cultured. Cells were exposed to thermal stress at varying times and temperatures and evaluated for survival and viability with crystal violet and MTT assays. Both the MTT and crystal violet assay demonstrated statistically superior rates of viability and survival for A549 (lung carcinoma), FU-UR-1 (renal carcinoma), K1 (thyroid carcinoma), and MG-63 (osteosarcoma) cell lines compared to control (HEK293 cells) at 60°C. Additionally, the MTT assay demonstrated superior viability for PC3 (prostate carcinoma), MCF7 (breast carcinoma), and A498 (renal carcinoma) compared to control. All cell lines demonstrated significantly decreased survival and viability in temperatures more than 90°C. This study demonstrated in vitro thresholds for thermal necrosis for cell lines of common orthopedic tumors of bone. The A549 (lung carcinoma), K1 (thyroid carcinoma), and FU-UR-1 (renal carcinoma) cell lines demonstrated greater resistance to heat stress compared to non-neoplastic control cells. Temperatures in excess of 90°C are necessary to reliably reduce cell survival and viability to less than 10%.

Early outcome of surgery, triamcinolone and silicone gel combination therapy for earlobe keloid: our local experience

Background: Earlobe keloids cause facial disfigurement, physical, emotional and psychological burden to patients, while posing an intriguing treatment challenge to the plastic surgeon. Different options of combination therapy have been used in the treatment of earlobe keloids with varied success rates. Methods: This interventional prospective hospital-based study was carried out in Irrua Specialist Teaching Hospital, Irrua, Edo State, over a 15-month period (October 2017 to December 2018). Forty-two patients with earlobe keloids who met the inclusion criteria were serially recruited into the study. Forty-eight earlobe keloids in 41 patients had the intralesional excision biopsy, intralesional triamcinolone injection and silicone gel combination therapy. A modified Sharquie et al’s scar grading system was applied pre-intervention to record the baseline scores and post-intervention to evaluate the patients’ rate of response. Post treatment complications were identified, and the patients were followed up for six months. Results: Most of the patients with earlobe keloids fell in the age group 21-30 years and the male-female ratio was 1:19.5. Multiple earlobe piercing had significant association with the development of earlobe keloids. 95.8% of treated lesions had complete response to therapy. Two (4.2%) patients had dyschromia following treatment. Conclusions: The triple therapy combination of intralesional excision biopsy, postoperative intralesional triamcinolone injection and topical silicone gel application is a readily available, safe and efficacious treatment modality for earlobe keloids. Thus, it can be used as a first-line treatment modality.

Computer navigation-guided transpedicular excision of L4 vertebral body osteoblastoma

Abstract Osteoblastoma is a benign bone tumor that accounts for 10% of all spinal tumors and mostly arises from the posterior spinal elements. Isolated vertebral body osteoblastoma is relatively rare and generally requires extensive surgery. We report a rare case of L4 vertebral body osteoblastoma, which was managed successfully by computer navigation-guided transpedicular excision. A 22-year-old female presented with progressive lower back pain for the past six months. Radiological investigation revealed a sclerotic lesion involving the anterior cortex with a prominent central nidus in the anterior part of the L4 vertebral body. Based on the lesion size, a diagnosis of benign osteoblastoma (Enneking stage 2) was made, and she underwent computer navigation-assisted intralesional excision of the lesion by the bilateral transpedicular route. Histopathological examination confirmed the diagnosis of osteoblastoma. In the immediate postoperative period, the patient was completely relieved of symptoms, and the final follow-up magnetic resonance imaging showed no evidence of recurrence at the end of seven years. The intraoperative 3D navigation technology allowed a transpedicular minimal access approach to excise an osteoblastoma of the L4 vertebral body while preserving intervertebral stability and decreasing morbidity.

Efficacy of imiquimod in the management of lentigo maligna.

Lentigo maligna (LM) is a melanocytic proliferation occurring on photo-exposed skin that may progress to LM melanoma. Surgery is recommended as first-line treatment. Excision margins of 5-10 mm remain, without international consensus. Several studies have shown that imiquimod, an immunomodulator, induces LM regression. This study investigated the effect of imiquimod versus placebo in neoadjuvant settings. We performed a prospective, randomized, multicentre, phase III clinical study. Patients were randomly assigned in 1:1 ratio to receive imiquimod or placebo for 4 weeks, followed by LM excision 4 weeks after the last application of imiquimod or placebo. The primary endpoint was extra-lesional excision, with a 5 mm margin from the residual pigmentation after imiquimod or vehicle. Secondary endpoints included the gain on the surface removed between the two groups; number of revision surgeries to obtain extra-lesional excisions; relapse-free time; and number of complete remissions after treatment. A total of 283 patients participated in this study; 247 patients, 121 patients in the placebo group and 126 in the imiquimod group, accounted for the modified ITT population. The first extralesional extirpation was performed in 116 (92%) imiquimod patients and in 102 (84%) placebo patients; the difference was not significant (p = 0.0743). Regarding the surface of LM, imiquimod reduced the LM surface (4.6-3.1 cm2 ) significantly (p < 0.001) more compared to the placebo (3.9-4.1 cm2 ). Imiquimod reduces the lentigo maligna surface after 1 month of treatment, without a higher risk of intralesional excision and with a positive aesthetic outcome.

Simple curettage and allogeneic cancellous bone chip impaction grafting in solitary enchondroma of the short tubular bones of the hand

Enchondroma is the most common bone tumor in the hand. While standard surgical procedure is intra-lesional excision and bone grafting, there is a dispute between allogeneic bone, autogenous bone, and synthetic bone substitute grafting. Diverse adjuvant treatments have been introduced to reduce recurrence, but results are mixed with controversies. Meanwhile, whether existing descriptive classification could predict treatment outcome remains unclear. Thus, we reviewed patients with solitary enchondroma of the hand who underwent simple curettage followed by allogeneic cancellous bone chip impaction grafting. Eighty-eight patients with more than 5 years of follow-up were enrolled. Demographic data, local recurrence, and complications were reviewed. Duration of consolidation and the difference according to Takigawa classification were assessed. Range of motion (ROM), and functional scores were also evaluated. There were 51 women and 37 men, with a mean age of 37.9 years. Mean follow-up was 10.2 years. Recurrence occurred only in one patient. There was no complication. Mean postoperative total active motions of fingers and thumb were 239° and 132.9°. Mean modified Disabilities of the Arm, Shoulder, Hand score, and Musculoskeletal Tumor Society Score were 1.63, and 99.2 at the last follow-up. Consolidation, ROM, and functional scores according to Takigawa classification showed no significant differences. This study suggests that simple curettage with impaction grafting of allogeneic cancellous bone chip is a feasible method for treating solitary enchondromas involving short tubular bone of the hand with good long-term outcomes. Postoperative recurrence and complication rates were very low. Radiographic and clinical results were good regardless of the previous radiological classification.

Prognostic factors of recurrence after an intralesional excision of benign bone tumour in the peripheral skeleton

Background: Most aggressive benign bone tumours are treated surgically by an intralesional excision and bone defect filling. The primary aim of our study was to evaluate prognostic factors of recurrence after an intralesional excision of a benign bone tumour in the peripheral skeleton. We asked whether patient age and gender, maximal tumour diameter, histological diagnosis, and the tumour’s location statistically significantly impact postoperative tumour recurrences. The secondary aim was to evaluate preoperative differences between different histopathological groups of benign bone tumours and the impact of age and gender, maximal tumour diameter, histological diagnosis, and the tumour location on the number of diagnostic biopsies and curative surgical procedures.&#x0D; Methods: Retrospective analysis of prospectively collected data included a cohort of patients operated on at a single tertiary tumour centre between 2010 and 2020 with at least one-year follow-up. Ordinal logistic regression was used to assess the influence of input variables on the number of diagnostic/curative surgical procedures and postoperative recurrences.&#x0D; Results: The cohort analysis included 261 patients with 61 local recurrences. The risk of tumour recurrence was significantly lower with higher patient age (p = 0.001) and tumour location in the distal femur (p = 0.033). Higher number of diagnostical procedures correlated with higher patient age (p = 0.028), larger maximal tumour diameter (p = 0.035) and connective tissue tumour diagnosis (p = 0.027). Higher number of curative procedures correlated with larger maximal tumour diameter (p = 0.008) and lower patient age (p = 0.001).&#x0D; Conclusions: Preoperative features of benign bone tumours significant impact the number of surgical procedures needed to treat the tumour and the risk of postoperative recurrence. Although most of these factors are nonmodifiable, they represent an incentive to create evidence-based guidelines for biopsy indications, surgical techniques and consistent postoperative follow-up.

Custom-Made 3D-Printed Implants for Anterior Column Reconstruction in the Upper Cervical Spine after Intralesional Extracapsular Excision-Report of 2 Cases and Literature Review.

The use of three-dimensional (3D)-printed custom-made implants is spreading in the orthopedics field for the reconstruction of bone losses or for joint replacement, thanks to their unparalleled versatility. In particular, this novel technology opens new perspectives to formulate custom-made fixation strategies for the upper cervical region, sacrum and pelvis, where reconstruction is challenging. We report and analyze the literature concerning upper cervical reconstruction with 3D-printed personalized implants after tumor surgery, and discuss two cases of patients where this technology was used to reconstruct the anterior column after extracapsular debulking of C2 recurrent chordoma at our institution.

Intralesional Keloid Excision Followed by Single Fraction Electron Beam Radiotherapy and Postoperative Local Steroids: a Non-randomized Open Study on Recurrence Rate

Intralesional Keloid Excision Followed by Single Fraction Electron Beam Radiotherapy and Postoperative Local Steroids: a Non-randomized Open Study on Recurrence Rate

Treatment of pseudocyst of auricle

Pseudocysts of the auricle are an uncommon yet challenging benign condition characterized by painful cystic swelling of the ear.1 Treatment modalities such as intralesional triamcinolone, cryosurgery, excision, and deroofing are not always successful because recurrence is common.1,2 Additionally, the underlying avascular cartilage and cosmetically sensitive location provide additional challenges. A 37-year-old woman was referred for a 2-year history of an exquisitely tender pseudocyst of the auricle (Supplemental Fig 1, available via Mendeley at https://data.mendeley.com/datasets/g9ckychcgk/2) that was recalcitrant to conservative measures such as rest, pressure offloading, and intralesional triamcinolone.

Osteofibrous dysplasia of the tibia : the importance of deformity in surveillance.

Osteofibrous dysplasia (OFD) is a rare benign lesion predominantly affecting the tibia in children. Its potential link to adamantinoma has influenced management. This international case series reviews the presentation of OFD and management approaches to improve our understanding of OFD. A retrospective review at three paediatric tertiary centres identified 101 cases of tibial OFD in 99 patients. The clinical records, radiological images, and histology were analyzed. Mean age at presentation was 13.5 years (SD 12.4), and mean follow-up was 5.65 years (SD 5.51). At latest review, 62 lesions (61.4%) were in skeletally mature patients. The most common site of the tibial lesion was the anterior (76 lesions, 75.2%) cortex (63 lesions, 62.4%) of the middle third (52 lesions, 51.5%). Pain, swelling, and fracture were common presentations. Overall, 41 lesions (40.6%) presented with radiological deformity (> 10°): apex anterior in 97.6%. A total of 41 lesions (40.6%) were treated conservatively. Anterior bowing < 10° at presentation was found to be related to successful conservative management of OFD (p = 0.013, multivariable logistic regression). Intralesional excision was performed in 43 lesions (42.6%) and a wide excision of the lesion in 19 (18.8%). A high complication rate and surgical burden was found in those that underwent a wide excision regardless of technique employed. There was progression/recurrence in nine lesions (8.9%) but statistical analysis found no predictive factors. No OFD lesion transformed to adamantinoma. This study confirms OFD to be a benign bone condition with low rates of local progression and without malignant transformation. It is important to distinguish OFD from adamantinoma by a histological diagnosis. Focus should be on angular deformity, monitored with full-length tibial radiographs. Surgery is indicated in symptomatic patients and predicted by the severity of the initial angular deformity. Surgery should focus more on the deformity rather than the lesion. Cite this article: Bone Joint J2022;104-B(2):302-308.

Giant Cell Tumor of Bone Versus Tenosynovial Giant Cell Tumor - Similarities and Differences.

Giant cell tumor of bone (GCTB) and tenosynovial giant cell tumor (TGCT) share misleadingly similar names, soft texture and brown color macroscopically, osteoclast-like multinucleated giant cells microscopically and localisation in the musculoskeletal system. However, these two tumor types are biologically and clinically two distinct entities with different natural courses of progression and considerably different modes of surgical and medical treatment. In this article, we provide a detailed update on the similarities and the differences between both tumor types.GCTB is a locally aggressive osteolytic bone tumor, commonly seen in patients in their third decade of life. It usually occurs as a solitary lesion in the meta-epiphyseal region of long bones. It can be diagnosed using plain radiographic imaging, CT radiography or MRI to estimate the tumor extent, soft tissue and joint involvement. GCTB is usually treated with intralesional excision by curettage. Systemically, it can be treated with bisphosphonates and denosumab or radiotherapy.TGCT is a rare, slowly progressing tumor of synovial tissue, affecting the joint, tendon sheath or bursa, mostly seen in middle-aged patients. TGCT is usually not visible on radiographs and MRI is mostly used to enable assessment of potential bone involvement and distinguishing between two TGCT types. Localised TGCT is mostly treated with marginal surgical resection, while diffuse TGCT is optimally treated with total synovectomy and is more difficult to remove. Additionally, radiotherapy, intraarticular injection of radioactive isotopes, anti-TNF-α antibodies and targeted medications may be used.

Fully Digital Workflow for Fabrication of A 3D Printed Ear Stent for Auricular Keloids: A Technique Article.

Keloids are skin lesions which result from an aberration in the physiological healing process marked with overgrowth of collagen fibers. Keloid of the ear is cosmetically challenging and has an increased chance of re-growth. To minimize recurrence, pressure therapy in combination with other treatment forms has been used. Various techniques have been used to fabricate a passive or active stent. This report presents a fully digital workflow to fabricate an ear stent after intralesional excision and skin autografting of an extensive recurrence of a keloid lesion of the left ear involving the helix, antihelix, scapha, and conchal bowl.