This case report and literature review detail and contextualise the finding of a positive sentinel node in the contralateral axilla of a 69-year-old male with cutaneous malignant melanoma of the left chest wall. Excision biopsy confirmed nodular melanoma (Breslow thickness 6.6 mm; mitotic index 11; no ulceration or microsatellites; completely excised; pT4a). Preoperative lymphoscintigraphy identified the sentinel node in the right axilla. The patient underwent wide local excision with 2-cm margins and a sentinel lymph node biopsy, which showed no spread of disease. This was followed by six cycles of adjuvant pembrolizumab with surveillance scans remaining clear. Literature review identified 22 cases of anterior chest wall melanoma ( n = 4) or breast carcinoma ( n = 18) with contralateral drainage (12 case reports, two case series, and eight retrospective studies). Only one previous chest wall melanoma case with contralateral drainage was identified, but details were not reported. Thus, we present the first documented case of anterior chest wall melanoma with a contralateral sentinel node, and emphasise the importance of thorough evaluation of suspicious lesions for unexpected drainage patterns.

Contemporary Management of Dermatofibrosarcoma Protuberans.

Treatment of head and neck squamous cell carcinoma (HNSCC) includes wide local surgical excision followed by adjuvant therapy. Objectives: To determine the frequency of hearing loss in patients who underwent concurrent chemo-radiation therapy (CCRT) treatment after surgical removal of tumour of the oral cavity. Methods: This cross-sectional study was conducted at the Department of ENT and Head and Neck Surgery, Liaquat National Hospital, Karachi, from March 2025 to August 2025. Using non-probability consecutive sampling, 133 patients aged 18–70 years with histopathologically confirmed grade III or higher oral cavity malignancies planned for post-surgical CCRT were enrolled. Hearing was assessed using pure-tone audiometry pre-surgery, two weeks post-surgery, and three months post-CCRT, and categorised by severity. Data were analysed with SPSS version 26.0, using descriptive statistics and chi-square tests, with p<0.05 considered significant. Results: Among 133 post-surgical CCRT patients, 94 (70.7%) were male, and the median age was 48.0 (39.0–58.0) years. T4 disease was present in 114 (85.7%) patients. Hearing loss occurred in 15 (11.3%), highest in >60 years 5 (33.3%, p=0.016), and most frequent in tongue malignancy 10 (66.7%). By CCRT cycles, loss was seen in 1–2 cycles 3 (20.0%), 3–4 cycles 12 (10.5%), and none in >4. Severity of hearing loss was found to have a significant association with cancer, stating (p=0.031). Conclusions: Hearing loss following CCRT for oral cavity malignancies occurred in around one in ten patients, with most cases being mild and associated with older age, tongue primary site, and advanced T stage.

Introduction: Cutaneous squamous cell carcinoma (cSCC) is a common nonmelanoma skin cancer primarily driven by chronic sun exposure and advanced age. Standard treatments include wide local excision, Mohs surgery, and radiotherapy, with advanced cases often managed with chemotherapeutics. PD1 inhibitors like cemiplimab and pembrolizumab are FDA-approved treatments that have shown efficacy in locally advanced or metastatic cSCC not amenable to surgery or radiation. Objectives: This study evaluated clinical responses to these inhibitors using RECIST 1.1 criteria through direct visual examination, addressing the applicability of the criteria in real-world clinical practice. Methods: A cohort of 12 patients with cSCC treated at Duke University with cemiplimab or pembrolizumab was identified through the DeDUCE database using ICD-10 codes. Clinical responses were determined using RECIST 1.1 and modified WHO criteria and compared against clinical-based assessments. Results: Results indicated varied responses: seven patients with progressive disease (PD), two with stable disease (SD), and three with complete response (CR). Challenges included distinguishing true progression from reactive conditions like erosive pustular dermatosis (EPD) and pseudoprogression as well as evaluating partial responses in ulcerated lesions, which are not defined within the criteria. Radiologic findings often required corroboration with clinical evaluations to avoid misclassification. Conclusions: Accurate clinical determination of cSCC response to PD-1 inhibitors is complex, requiring multidisciplinary approaches and meticulous wound care. Incorporating these clinical nuances into revised response criteria would enhance treatment decision-making, balancing the risks of premature discontinuation against prolonged ineffective therapy.

Rectal cancer management has increasingly shifted toward organ-preserving strategies that aim to maintain oncologic control while preserving bowel, urinary, and sexual functions. Although radical surgery remains highly effective, its substantial long-term functional morbidity underscores the need for less invasive, risk-adapted approaches. This review summarizes current evidence and emerging directions in organ-preserving treatment for rectal cancer, with a particular focus on the evolving role of endoscopists in patient selection, treatment decision making, endoscopic treatment, and post-treatment surveillance. Recent advances in risk stratification have improved the potential for more accurate patient selection. Refined histopathological risk criteria, predictive nomograms, artificial intelligence-based models, and emerging liquid biopsy biomarkers, such as circulating tumour DNA, are being explored to better estimate the risk of lymph node metastasis after endoscopic resection. In parallel, novel endoscopic techniques, such as peranal endoscopic myectomy and endoscopic intermuscular dissection, have expanded the technical feasibility of en bloc resection for challenging rectal lesions. Local excision followed by adjuvant chemoradiotherapy represents a promising investigational strategy, with ongoing trials, such as TESAR and JCOG1612 (RESCUE), that are expected to clarify its safety and efficacy. Total neoadjuvant therapy has become a central treatment paradigm for locally advanced rectal cancer, achieving higher pathological complete response rates and improved disease-related outcomes compared with conventional neoadjuvant chemoradiotherapy. Additionally, non-operative management (watch-and-wait) after total neoadjuvant therapy, supported by prospective trials and international registries, has established a strong evidence base for organ preservation in carefully selected patients. In molecularly selected patients with mismatch repair-deficient or microsatellite instability-high tumours, immune checkpoint inhibitor-based therapy has emerged as a promising organ-preserving strategy, although current evidence remains limited to early-phase prospective studies. Despite these advances, optimal patient selection and long-term oncologic safety remain under investigation. Further prospective studies and international collaboration are needed to establish robust evidence and optimize the implementation of organ-preserving strategies in rectal cancer.

Background: Benign fibrous histiocytoma (BFH), also known as dermatofibroma, is a common benign cutaneous mesenchymal tumor. Despite its benign nature, it may mimic other spindle cell lesions clinically and histologically, necessitating accurate diagnostic evaluation. Case Presentation: We report a case of a patient presenting with a slowly growing, painless cutaneous dermal nodule. Complete local surgical excision was performed for diagnostic and therapeutic purposes. Histopathological Findings: Microscopic examination revealed a dermal-based spindle cell proliferation arranged in a storiform pattern, composed of fibroblast-like cells without cytologic atypia, necrosis, or increased mitotic activity. Immunohistochemical analysis showed positivity for CD68 and negativity for CD34, supporting the diagnosis of benign fibrous histiocytoma and excluding malignant spindle cell neoplasms. Conclusion: This case highlights the importance of histopathological evaluation supported by immunohistochemical analysis in the accurate diagnosis of benign fibrous histiocytoma. In the present case, complete surgical excision was followed by a favorable outcome, reinforcing the value of a systematic diagnostic approach.

TEM OR ESD IN EARLY RECTAL TUMORS: A CLINICAL & COST-EFFECTIVENESS ANALYSIS.

(1) Background/Objectives: Human papillomavirus (HPV) testing is hypothesised to detect cervical intraepithelial neoplasia grade 3 (CIN3) earlier than cervical cytology, which could translate into several clinical benefits. This study aimed to confirm that HPV testing detects CIN3 lesions of smaller size (or linear extension) and to assess whether this is associated with a decreased risk of stromal microinvasion (≤3 mm) (microinvasive or stage IA1 cervical carcinoma). (2) Methods: The study was conducted in a referral centre for cervical pathology in Italy. Eligible were 3744 patients aged 30–64 years who underwent local excision of the cervix between 1992 and 2021 and were diagnosed with CIN3, with or without microinvasion. Data were analysed using logistic and multinomial regression models. (3) Results: Overall, 1156 (30.9%) CIN3 cases were detected by the HPV test, and 2588 (69.1%) by cervical cytology. The lesion size was smaller in HPV test-detected CIN3 (median, 6 mm; interquartile range (IQR), 4–8 mm) than in cytology-detected CIN3 (median, 7 mm; IQR, 5–9 mm; p < 0.001). HPV test-detected CIN3 was over 50% less likely to have a size >6 mm combined with massive glandular crypt involvement. Stromal microinvasion occurred in 20/1156 (1.7%) HPV test-detected lesions versus 87/2588 (3.4%) cytology-detected lesions (p = 0.006), corresponding to an approximately 50% lower age-adjusted risk. The smaller size of HPV test-detected CIN3 and its lower degree of glandular crypt involvement interacted additively, rather than multiplicatively, in reducing the risk of stromal microinvasion. Over 46% of the association between detection mode and stromal microinvasion was explained by the size/involvement composite variable. (4) Conclusions: HPV testing detects CIN3 lesions of smaller size than cervical cytology. HPV test-detected CIN3 has a lower risk of stromal microinvasion. This association is mediated to a substantial extent by the smaller lesion size and the less extensive glandular crypt involvement, which interact in an additive manner. These findings may have other important clinical implications. First, the prevalence of disease persistence after treatment may decrease. Second, smaller lesions are likely to be treated with more limited excisions. Third, this may contribute to a lower rate of preterm birth in subsequent pregnancies.

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour with a locally infiltrative growth pattern that has high rates of recurrence. Mohs micrographic surgery is recommended as the gold-standard treatment over wide local excision (WLE) due to tissue-sparing and reduced recurrence rates. No previous data on surgical outcomes following Mohs Micrographic Surgery (MMS) for DFSP have been reported in Australia to date. This study aims to review the outcomes of DFSP treated with frozen-section MMS across three centres in New South Wales (NSW), Australia, and compare these outcomes with those in the current literature. A retrospective review of patients who underwent MMS for DFSP between 2010 and 2023 was performed. Patient demographics, histological findings, surgical treatment and follow-up data were collected. Recurrence was assessed through electronic medical records, clinical assessments by a dermatologist or general practitioner, and patient self-report. In all, 38 cases of DFSP were included (27 female, 11 male; median age 39 years, range 16-64). The trunk was the most common site. Clinical margins and Mohs stages were recorded in 37 of 38 cases, with 73% of cases cleared with clinical margins of ≤ 20 mm. Clinical or self-reported follow-up was available for 28 of 38 patients (73.6%) over a mean of 51 months (range, 5-132 months). No local recurrences were identified during this period. This is the first Australian case series on MMS for DFSP. Our findings demonstrate no recurrences with follow-up and demonstrate that MMS may achieve clearance with smaller clinical margins than WLE. These results support international guidelines recommending MMS as the gold-standard treatment and highlight the need to improve access to MMS in Australia.

ABSTRACTSolid papillary carcinoma of the breast is a rare histopathological subtype of papillary neoplasms, and its in situ variant localized to the nipple is particularly uncommon. Current oncology literature provides limited evidence on standardized diagnostic criteria, biological behavior, and optimal treatment strategies for this entity. We describe a 73‐year‐old Chinese woman with a two‐year history of a left nipple mass that developed erythema and ulceration five days prior to presentation. Imaging studies (ultrasonography and MRI) identified an isolated nipple lesion (BI‐RADS 4b) with no other breast tissue involvement. Wide local excision confirmed solid papillary carcinoma in situ (pTisN0M0), with pathological evaluation showing R0 resection margins. The patient received standard adjuvant endocrine therapy (letrozole 2.5 mg/day) and showed no evidence of recurrence at 9 month follow‐up. For patients with nipple‐confined solid papillary carcinoma lacking high‐risk features, complete surgical excision constitutes the mainstay of treatment, complemented by postoperative adjuvant endocrine therapy to mitigate recurrence risk.

We report outcomes of patients who received intraoperative radiation therapy (IORT) using 50kV after lumpectomy and sentinel lymph node biopsy. Women with age > 45 and post-menopausal status, localized, unifocal, invasive breast carcinoma were included in the study. Patients were diagnosed by needle biopsy, and suitable for wide local excision of invasive ductal carcinoma without nodal involvement on conventional examination (cT1 and small cT2 ≤ 3.5cm, cN0, M0). Overall, 489 patients who received adjuvant IORT after breast-conserving surgery were identified between March 2016 to June 2023. The median age was 68 years (range 49-93). The median tumor size was 8mm (0-40mm). Adjuvant whole breast adiation therapy (WBRT), chemotherapy and endocrine were additionally offered in 36 patients (7.4%), 12 (2.4%) and 384 patients (78.5%) respectively. After a median follow-up of 36 months (range, 0-100), the 3-year LR was 1.4% (95% CI 0.6-3.1%). The 3-year LRFS, LRRFS, and PFS were each 97.1% (95% CI 94.6-98.5%), while the 3-year MRFS and OS were both 98.3% (95% CI 96.1-99.2%). The 3-year outcomes did not differ significantly between the IORT and IORT + WBRT cohorts. Patients who did not receive ET (n = 104) experienced a significantly higher rate of local recurrence compared with those who received ET (n = 384) (3-year LR 4.0% vs. 0.7%; p = 0.01). LRFS and LRRFS showed borderline significance (5-year LRFS 96.9% vs. 100%; p = 0.05). MRFS, PFS, and OS did not differ significantly between the two groups. Preliminary 3-year results show that IORT with 50kV achieves excellent local control in selected early-stage breast cancer patients. Endocrine therapy reduced local recurrence, while WBRT added no significant benefit, underscoring the need for longer follow-up.

Aggressive angiomyxoma (AA) is a rare, benign but locally invasive mesenchymal tumor arising from myxoid connective tissue, predominantly affecting women of reproductive age. Its clinical presentation is often nonspecific, frequently mimicking other pelvic or perineal pathologies, which leads to delayed diagnosis. We report an exceptional case of AA presenting as a massive, irreducible pelvic organ prolapse. A healthy multiparous woman in her 40s presented to a Urogynecology Consultation with a 6-year history of a progressively enlarging perineal mass, initially interpreted as a complete pelvic organ prolapse. She reported no pain or systemic symptoms. Clinical examination revealed a large, irreducible perineal mass measuring approximately 30 cm, resembling a fourth-degree uterovaginal prolapse. Pelvic magnetic resonance imaging demonstrated a volumous heterogeneous mass extending from the umbilical region and prolapsing through the perineum. A percutaneous biopsy revealed a mesenchymal neoplasm with smooth-muscle differentiation, initially suggestive of a pelvic leiomyoma. No metastatic lesions were detected on chest computed tomography. The patient underwent wide local excision of the tumor, total hysterectomy, and anterior rectal resection with a temporary colostomy. Histopathological examination confirmed the diagnosis of aggressive angiomyxoma. The postoperative course was uneventful, and intestinal continuity was later restored. The patient remains asymptomatic and disease-free under regular follow-up. This case highlights the diagnostic challenge posed by aggressive angiomyxoma due to its slow growth, deep pelvic location, and clinical resemblance to more common urogynecologic conditions such as pelvic organ prolapse or leiomyoma. MRI remains the imaging modality of choice for preoperative assessment, while complete surgical excision with clear margins is the mainstay of treatment. Given its high recurrence potential, long-term follow-up is essential. Awareness of this rare entity is crucial for early recognition and appropriate multidisciplinary management.

Transanal Minimally Invasive Surgery (TAMIS) is a viable technique for local excision of rectal lesions, offering improved access, specimen quality and recurrence rates compared to traditional methods. While most published data are from tertiary centres, this study evaluates the outcomes of TAMIS performed at a regional New Zealand hospital. A retrospective analysis was conducted on all patients who underwent TAMIS at Tauranga Hospital between December 2014 and October 2025. Demographic, operative, histopathological, morbidity and 30-day mortality data were collected. Complications were classified using the Clavien-Dindo system. Sixty five patients (mean age 69; 69% male) underwent TAMIS over the study period. The mean resection size was 41 × 29 mm. Histological diagnoses included adenomas (n = 35), adenocarcinomas (n = 20), carcinoid tumour (n = 1), gastrointestinal stromal tumour (n = 2), benign scar tissue (n = 6) and rectal prolapse (n = 1). R0 resection was achieved in 97% of polyps and 85% of adenocarcinomas. The mean length of stay was 1.5 days. Complications of Clavien-Dindo grade II occurred in 11.0% and grade III in 6%, with postoperative haemorrhage being most common. One mortality occurred within 30 days postoperatively (1.6%). None of the adenocarcinoma patients developed recurrence; two (6%) patients had recurrent adenomas both successfully managed with local treatment. TAMIS can be performed safely and effectively in a regional centre, providing acceptable morbidity and mortality rates for a wide range of rectal pathologies.

Introduction: Cutaneous squamous cell carcinoma (SCC) commonly affects sun-exposed areas, particularly the dorsum of the hand. However, palmar SCC is rare and can remain undiagnosed for a prolonged period. This case describes a unique instance of SCC originating from the palm with metastasis, initially misdiagnosed as primary breast cancer. Case Presentation: A 75-year-old woman, a retired agricultural laborer, presented with a chronic ulcerated mass on her right palm, with associated weight loss and regional nodal swellings. She had a traumatic palm injury treated with skin grafting 12 years prior. She previously underwent axillary and breast surgeries for lesions diagnosed as SCC, presumed to be of breast origin. Current examination revealed a 2.5 × 2 cm palmar mass and multiple nodal swellings. Biopsies confirmed well-differentiated SCC at all sites, and imaging showed no distant metastases but significant right-sided nodal involvement. The patient underwent wide local excision of the palm, modified radical mastectomy, and neck dissection, followed by split-thickness skin grafting. Recovery was uneventful. Clinical Discussion: Palmar SCC may arise from chronic inflammatory changes or trauma rather than UV exposure, as seen in this case. Misdiagnosis delayed appropriate treatment and allowed for significant nodal progression. SCC in atypical sites can be aggressive and necessitate early, multidisciplinary intervention. Conclusion: Palmar squamous cell carcinoma, although rare, must be considered in chronic non-healing hand ulcers, especially in patients with previous trauma or grafting. Thorough clinical correlation with histopathology, early biopsy, and prompt surgical management are essential to reduce morbidity from metastatic spread.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor that poses significant diagnostic and management challenges. In resource-limited settings such as Libya, insufficient awareness and limited diagnostic facilities may contribute to frequent misdiagnosis and delayed treatment. This study aimed to assess healthcare professionals’ experience, diagnostic approaches, and management strategies for DFSP in Libya. A cross-sectional survey was conducted among 213 healthcare professionals, including dermatologists, surgeons, oncologists, pathologists, radiologists, and general practitioners from various regions of Libya. Data were collected using a standardized questionnaire covering demographic characteristics, experience with DFSP, diagnostic methods, treatment practices, perceived challenges, and recommendations for improvement. Among participants, 65.7% had previously encountered DFSP cases, and 79.8% reported familiarity with the disease. Misdiagnosis was common, with lipoma (39.9%), keloid (23.5%), and dermatofibroma (18.8%) being the most frequent initial incorrect diagnoses. Biopsy with histopathological examination was the primary diagnostic method (61.0%), while 43.2% routinely used immunohistochemistry (IHC), most commonly CD34 (37.6%). The majority of respondents (65.7%) believed that DFSP is often misdiagnosed in Libya. Preferred treatment modalities included wide local excision (56.3%) and Mohs micrographic surgery (23.5%). Major challenges identified were late diagnosis (46.9%), limited diagnostic resources (37.6%), and insufficient clinician awareness (32.9%). The most frequently suggested improvements were organizing training programs and workshops (70.4%) and enhancing diagnostic facilities (56.3%). Specialty and years of professional experience were significantly associated with disease familiarity and use of IHC (p < 0.05). This study highlights substantial diagnostic and management challenges related to DFSP in Libya, primarily due to limited awareness and inadequate diagnostic infrastructure. Targeted training initiatives, improved access to diagnostic tools, and the development of national management guidelines are essential to promote early diagnosis and optimal patient care.

The treatment of lentigo maligna (LM) can be challenging in elderly patients and in delicate facial areas. Previous studies have shown that 10% of LM are upstaged to LMM after surgery. This nationwide cohort study aimed to identify the choice and frequency of diagnostic and treatment modalities in LM patients in the Netherlands and to investigate the rate of upstaging to LMM after surgery and recurrences after treatment. To investigate the diagnostic modalities used to diagnose LM and the amount of upstaging to LMM after surgery, data from 2020 were retrieved from the Dutch Nationwide Pathology Databank (Palga). To investigate the treatment modalities for LM, data were retrieved from the Netherlands Cancer Registry between 2013-2016. To investigate recurrences after treatment, all LM reports from 2013 until 2021 were retrieved from Palga. In 2020, 1422 patients were diagnosed with primary LM in the Netherlands. Diagnoses were made using punch biopsy in 61% of cases and excisional biopsy in 37%. Half of the 1422 patients (50%) were treated with surgery, and 14% were upstaged to LMM/melanoma after surgery. Between 2013-2016, wide local excision was performed for 80% of 3587 histopathologically confirmed primary LM cases, staged excision was chosen in 2%, watchful waiting in 1.5%, and non-invasive treatments in 4.6% of cases. With a median follow-up until death or censoring of 5.7 years, there were 247 (6.9%) recurrences, with a median time to recurrence of 2.4 years. The most applied diagnostic modality in LM patients in the Netherlands is punch biopsy, and most LM patients are treated with wide local excision in line with the Dutch melanoma guidelines. In this nationwide database, 14% of the histologically proven LM cases were upstaged to LMM after surgery. This should be taken into account when choosing treatment modalities, especially when considering non-surgical treatment modalities. The significant number of recurrences among non-surgical therapies demonstrates the complexity of treating LM and the importance of balance between histological clearance and sometimes mutilating surgery in the head and neck region.

Colorectal cancer (CRC) is increasingly detected at an early stage through national screening programmes, including tumours confined to the submucosa (pT1). Many pT1 CRC are managed by local endoscopic excision, and histological risk assessment is central to determining the need for further treatment. Clinical and pathology data were analysed for screen-detected pT1 CRC removed by local excision within the English Bowel Cancer Screening Programme (BCSP) between 2021 and 2022. The completeness of data recorded in the Bowel Cancer Screening System (BCSS) was audited against national pathology guidance. Clinicopathological features and subsequent management were described. 1267 pT1 CRC from 1260 patients were identified. BCSS data were available for all cases, although some histological fields were incomplete or coded as 'not assessable'. Most tumours were adenocarcinoma, not otherwise specified (NOS) (95.7%) and well-moderately differentiated (90.4%). Venous, lymphatic and perineural invasion were recorded in 8.9%, 9.2% and 1.0% of cases, respectively. Complete local resection (R0) was documented in 643 tumours. Following local excision, 342 pT1 CRC (27.0%) received further treatment, most commonly colorectal resection (287 cases) or repeat local excision (23 cases). Lymph node metastases were reported histologically in 33 patients. This large, contemporary cohort demonstrates that the English BCSP holds rich clinical and histological data suitable for audit and research. The audit highlights parameters where assessment is constrained by specimen-related factors and where data entry could be improved. These data characterise the histological features of locally excised pT1 CRC and their subsequent management and provide a foundation for future outcome-focused studies.

Primary Cutaneous Ewing Sarcoma (PCES) is exceptionally rare and represent a notorious diagnostic mimicker of Merkel cell carcinoma (MCC), particularly when it aberrantly expresses neuroendocrine markers. This pitfall can lead to significant diagnostic error and inappropriate management. A 73-year-old woman presented with a progressive, FDG-avid nodule on the left upper arm. An initial punch biopsy revealed a malignant small round cell tumor with a classic neuroendocrine immunophenotype, including dot-like positivity for CK20 and Neurofilament, which did not allow distinction between PCES and MCC. Subsequently, wide local excision was performed. Histological and extensive immunohistochemical analyses were conducted on the excision specimen, and fluorescence in situ hybridization (FISH) was employed for molecular confirmation. Examination of the resectate showed a multinodular dermal tumor composed of uniform round cells. Immunohistochemistry revealed diffuse positivity for CD99 and NKX2.2, whereas S100 and SOX10 were negative. Crucially, FISH analysis confirmed an EWSR1::FLI1 gene fusion. The sentinel lymph node was negative for metastasis. This case exemplifies a profound diagnostic pitfall in which PCES closely mimicked the immunoprofile of MCC. It underscores that dot-like CK20 and Neurofilament staining are not entirely pathognomonic for MCC diagnosis. In the differential diagnosis of cutaneous round cell tumors, which includes metastases, melanoma, and several sarcoma types, the present case reveals the diagnostic challenges of cutaneous sarcomas and highlights the necessity of a multimodal approach for accurate diagnosis.

The nasal sidewall to the cheek comprises multiple aesthetic units-the nasal dorsum, cheek, and lower eyelid-each with distinct skin characteristics. Its reconstruction requires careful planning to achieve functional and aesthetic harmony. Here, the authors report the case of a 42-year-old man with basal cell carcinoma of the left nasal sidewall extending to the cheek. After wide local excision with negative margins, the defect measured 18 to 28mm. Reconstruction combined cheek rotation and bipedicled V-Y advancement flaps, designed along the nasal aesthetic line, ensuring coincidence of the final scar with the natural contour. Both flaps survived without necrosis. At 2.5 years postoperatively, facial symmetry was preserved, with no recurrence, scar contracture, or eyelid malposition. This technique avoids transverse scarring across the nasal dorsum, preserves facial unit textures, and provides a natural three-dimensional contour. Although the bipedicle flap has limited mobility, it ensures stable perfusion and excellent cosmetics for moderate-sized defects.

Reconstruction after Mohs micrographic surgery (MMS) or wide local excision (WLE) requires careful consideration of defect size, location, depth, margin status, and patient preferences to optimize cosmetic, functional, and oncologic outcomes. The role of delayed full-thickness skin grafts (FTSGs) during reconstruction after skin cancer removal remains less defined. To characterize the indications, technique, and efficacy of delayed FTSG after MMS or WLE for skin cancer. Databases were searched for studies on delayed FTSG after MMS or WLE for skin cancer removal. Data were extracted on study design, patient and tumor characteristics, surgical details, graft technique, and outcomes including graft success, complications, and aesthetic/functional results. Twenty-four studies comprising 665 patients were included. The mean age was 63.8 years, and most patients were male (52.6%). The average delay to grafting was 16.5 days, with an overall graft success rate of 89.6% at an average follow-up period of 13 months. The optimal time to delay was 2 to 3 weeks with grafts placed in ≤1 week demonstrating significantly lower success. Outcomes were overall assessed as favorable, and patients were satisfied with their results. Delayed FTSGs remain a viable and highly effective option for reconstructing skin cancer defects.