Wide Excision Research Articles

Familial Arteriovenous Malformation in Extremity: A Case Report

Arteriovenous malformation (AVM) is a genetic vascular anomaly that can significantly affect daily activities. Its occurrence varies by race and gender, being more common in women. This report examines AVM in two siblings, aged 12 and 14. Clinical, radiological, and pathological evaluations revealed differing tumor sizes, expansions, and causes of vascular enlargement. Consequently, the siblings received different treatments: one underwent embolization, while the other had a wide excision. Both approaches resulted in favorable outcomes. AVM is a vascular neoplasm that may present at birth or be discovered later, often during routine check-ups or after trauma. The familial nature of AVM in this case emphasizes the variability in presentation and treatment response. Established diagnostic and therapeutic guidelines may not always be applicable, necessitating individualized treatment plans. This case highlights the importance of tailored treatment approaches for familial AVM, demonstrating successful outcomes with both embolization and wide excision

Guidelines How to Integrate Surgery and Targeted Therapy with Biologics for the Treatment of Hidradenitis Suppurativa: Delphi Consensus Statements from an Italian Expert Panel.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent and painful nodules and abscesses in intertriginous skin areas, which can progress to sinus tract formation, tissue destruction, and scarring. HS is highly debilitating and severely impairs the psychological well-being and quality of life of patients. The therapeutic approach to HS is based on medical therapy and surgery. First-line medical therapy includes topical antibiotics, systemic antibiotics, and biologics. Main surgical procedures include deroofing, local excision, and wide local excision. Despite the availability of multiple therapeutic options, the rates of disease recurrence and progression continue to be high. In recent years, the possibility of combining biologic therapy and surgery has raised considerable interest. In a clinical trial, the perioperative use of adalimumab has been associated with greater response rates and improved inflammatory load and pain, with no increased risk of postoperative infectious complications. However, several practical aspects of combined biologic therapy and surgery are poorly defined. In June 2022, nine Italian HS experts convened to address issues related to the integration of biologic therapy and surgery in clinical practice. To this purpose, the experts identified 10 areas of interest based on published evidence and personal experience: (1) patient profiling (diagnostic criteria, disease severity classification, assessment of response to treatment, patient-reported outcomes, comorbidities); (2) tailoring surgery to HS characteristics; (3) wide local excision; (4) presurgery biologic treatment; (5) concomitant biologic and surgical treatments; (6) pre- and postsurgery management; (7) antibiotic systemic therapy; (8) biologic therapy after radical surgery; (9) management of adverse events to biologics; and (10) management of postoperative infectious complications. Consensus between experts was reached using the Estimate-Talk-Estimate method (Delphi Method). The statements were subsequently presented to a panel of 27 HS experts from across Italy, and their agreement was assessed using the UCLA Appropriateness Method. This article presents and discusses the consensus statements.

Preoperative three-dimensional simulation of the breast appearance after wide local excision or level one oncoplastic techniques for breast-conserving treatment does not set unrealistic expectations for aesthetic outcome: One-year follow-up of a randomised controlled trial

IntroductionSimulation of aesthetic outcomes of wide local excision and level one oncoplastic breast conserving treatment (BCT) using 3-dimensional surface imaging (3D-SI) prepares women for their aesthetic outcome. It remains unknown whether women’s memory of this information at the one-year follow-up matches their perception of reality or affects the quality of life. MethodsWith ethical approval, a prospective 3-arm RCT was conducted and it included 3D-simulation, viewing post-operative 2D photographs of other women and standard care. At one-year post-surgery, the participants completed a visual analogue scale (VAS) for the question “How well do you think the information about how your breasts are likely to look after surgery reflects how they actually look today?” and the BCT BREAST-Q module. The Kruskal–Wallis test was used to examine between-group differences at a 5% significance level. ResultsFrom 2017 to 2019, 117 women completed the primary endpoint of being informed about the aesthetic outcome via verbal description, photographs or simulation. Seventy-eight (74%) of the 106 women who remained eligible attended the one-year follow-up. The standardised preoperative 3D-SI simulation did not affect the patient’s perception of the aesthetic outcome compared to standard care or viewing 2D photographs as measured using the VAS (p = 0.40) or BREAST-Q scores for satisfaction with information (p = 0.76), satisfaction with breasts (p = 0.70), and psychosocial wellbeing domains (p = 0.81). DiscussionViewing their own 3D-SI standardised simulation did not significantly affect how the participants perceived their aesthetic outcome. In addition, it did not alter the patient-reported satisfaction. These results demonstrated that simulation for wide local excision or level one oncoplastic surgery does not set unrealistic expectations of the aesthetic outcome when used in a preoperative setting. SynopsisThe use of a non-bespoke three-dimensional simulation of the aesthetic outcome for breast conserving treatment in the preoperative setting does not over-inflate expectations compared to standard care.

Staging in thick cutaneous malignant melanoma: A sequenced approach

BackgroundPatients with thick cutaneous pT4 malignant melanoma are at high risk for metastatic disease and optimal staging is poorly defined. This study examines the frequency and modality of pre-operative staging to provoke thought on optimal staging. MethodsA retrospective study was performed of patients with clinical T4N0 melanoma diagnosed between 2015-2017. The modality (sentinel lymph node biopsy and/or imaging), timing, and findings of staging investigations were assessed. ResultsOne hundred thirty-six patients with pT4a or pT4b cutaneous melanoma and clinically negative regional lymph nodes were included. Forty patients underwent no staging. Thirty-six patients underwent pre-operative imaging, and of these, regional or distant disease was identified in seven patients (19%). Another 36 patients underwent upfront sentinel lymph node biopsy concurrently with wide local excision. A positive sentinel lymph node biopsy was found in eight (22%) of these patients of which two had regional or distant metastatic disease on post-operative imaging. Of 16 who underwent a sentinel lymph node biopsy after negative pre-operative imaging, three had a positive sentinel lymph node biopsy. ConclusionStaging is non-standardized and underutilized in patients with thick melanoma. With evolving systemic treatment options, a well-defined approach to staging, with consideration for pre-operative imaging in pT4 patients, is essential for high-risk patients.

Establishment of a trastuzumab-resistant extramammary Paget disease model: loss of PTEN as a potential mechanism.

Extramammary Paget disease (EMPD) is a rare, cutaneous intraepithelial adenocarcinoma typically treated with wide local excision. Unfortunately, a number of patients with metastases show poor responses to chemotherapy. While some studies have explored trastuzumab's effectiveness against EMPD positive for human epidermal growth factor receptor 2 (HER2), trastuzumab resistance (TR) may emerge after anti-HER2 therapy. In this study, we established TR EMPD patient-derived xenografts (PDX) that replicated the histological and HER2 expression traits of naive EMPD tumours. Cancer gene analyses revealed a loss of the PTEN gene in TR tumours, which was further confirmed by immunohistochemical staining and immunoblotting to test for protein expression levels. Reduced PTEN levels correlated with increased protein kinase B (Akt) phosphorylation and p27 downregulation, suggesting a potential mechanism for trastuzumab resistance in EMPD cells. In the trastuzumab-sensitive EMPD-PDX mouse model, PTEN inhibitors partially restored trastuzumab-mediated tumour regression. The TR EMPD-PDX responded favourably to targeted therapy (lapatinib, abemaciclib, palbociclib) and chemotherapy (eribulin, docetaxel, trastuzumab deruxtecan). This study demonstrates an innovative TR EMPD-PDX model and introduces promising antineoplastic effects with various treatments for TR EMPD tumours.

Darier Ferrand's dermato fibrosarcoma of the breast: About a case and literature review

Darier Ferrand's dermato fibrosarcoma protruding is the most common tumor of cutaneous sarcomas, recognized by its high potential for aggressiveness and local recurrences after surgery of up to 40%. The location of the DFS on the breast has been described as extremely rare. Histologically consisting of bundles of spindle cells arranged in a storiform pattern, but due to the immunoreactivity of CD34 in DFSP, its presentation can be confused with other malignancies or even benign lesions. The objective of this observation is to describe the anamnestic, clinical, histological, therapeutic and evolutionary aspects of a DFS located on the infero-outer quadrant of the left breast in a 38-year-old patient compared to the data in the literature. Our patient had consulted for a skin mass located on the infero-external quadrant of the left breast, with irregular surface, with multiple protruding and exophytic nodular lesions evolving for several years, without ulcerations, pain and no axillary lymphadenopathy. We find in his history a notion of chest trauma. Wide and deep surgical excision with a margin of 5cm in healthy skin was done and histopathological examination of the operative specimen confirmed the diagnosis of DFS. Adjuvant radiotherapy 60Gray at a rate of 2Gray per fraction 5 days per week was administered. This reputedly rare location overlaps in several aspects (anamnestic, clinical, epidemiological, evolutionary and therapeutic) with data from the literature. Keywords: Dermatofibrosrcoma, Darier and Ferrand, Cutaneous sarcomas, Recurrence.

Malignant phyllodes: 10 year review of management through a sarcoma service

BackgroundPhyllodes tumours of the breast are rare, and their treatment is still subject to discussion. They are classified as benign, borderline, or malignant based on histopathological characteristics of the stroma. This study demonstrates 10 years’ experience in diagnosis and management of malignant phyllodes. MethodsAll patients referred for discussion at our sarcoma multidisciplinary team meeting from 2003 to 2013 with a diagnosis of malignant phyllodes were identified. Patient demographics, biopsy details, excision extent, final pathology, reconstruction, adjuvant treatment, recurrence and overall survival were assessed. ResultsThirty patients were identified over the 10 year period. Eight (26.7 %) had their diagnosis upgraded to malignant phyllodes on completion excision, compared to initial biopsy. Nine (30 %) had breast surgery elsewhere as definitive treatment before referral to our service. Four of these (44.4 %) required more extensive excision and three developed metastases (33.3 %) and died. Twenty-one patients had primary surgery through our service and three (14.3 %) died from disease. Overall, 13 patients had radical mastectomy, 92.3 % with adequate margins (>1 cm histologically) and no local recurrence, 9 simple mastectomy 22.2 % with adequate margins and 1 local recurrence and 8 wide local excision with 37.5 % adequate margins and 1 local recurrence. ConclusionFor malignant phyllodes patients, the best chance to reduce recurrence and improve survival is adequate excision and radical mastectomy should be considered. For borderline lesions, consideration should be given for referral to a specialist centre and we recommend delayed reconstruction, because of the chance of histological upgrade to malignancy.

YAP1∷KMT2A fusion-positive sarcoma: An emerging soft tissue tumor entity with morphological features resembling a sclerosing epithelioid fibrosarcoma.

Sclerosing epithelioid fibrosarcoma (SEF) and low-grade fibromyxoid sarcoma (LGFMS) constitute a morphological continuum with certain overlapping histopathological features and MUC 4 immunopositivity. SEF is characterized by EWSR1 gene rearrangement, is relatively more aggressive and shows a limited response to chemotherapy. Lately, a subset of tumors with morphological features of SEF, but lacking MUC4 immunostaining and EWSR1 gene rearrangement have been observed. We report the first case of YAP1∷KMT2A-positive sarcoma from the Indian subcontinent along with a review of similar tumors reported previously. A case of 31-year-old male presented with a 3 cm painful lump in the right suboccipital region. Histopathological examination of the excised specimen revealed a cellular tumor composed of atypical spindle and epithelioid cells, exhibiting moderate nuclear pleomorphism, arranged in cords, embedded in a dense collagenous/hyalinized stroma. By immunohistochemistry, the tumor cells were diffusely positive for cyclin D1 and negative for MUC4, desmin, myogenin, β-catenin, STAT6, myoD1, SMA, and S100P. By fluorescence in-situ hybridization, EWSR1 gene rearrangement was negative. Next-generation sequencing (NGS) revealed YAP1exon5∷KMT2Aexon4 fusion. Given a positive resection margin, he underwent a revision surgery involving wide local excision of the lesion including the outer table of the occipital bone followed by image-guided radiation therapy. Over 2 years of his follow-up, the patient is alive with no evidence of recurrence. Thus, YAP1∷KMT2A positive sarcomas have distinct molecular and overlapping histopathological features with SEF, with relatively less aggressive disease course. Documentation of additional similar tumors with long-term follow-up is required.

Comparative Study between Matrix Rotation Technique versus Wide Local Excision of Carcinoma of the Breast Located in the Upper / Upper Outer Quadrant

Abstract Background The breast is a cornerstone image of femininity, and the heart of womanhood, as nourisher and comforter. These roles evoke the idea of the importance and the affection of this delicate organ has in the minds of women. Breast, according to national cancer institute, is the chief site of cancer in women in Egypt, representing ∼38.8% of total malignancies among Egyptian women; it is a crucial cause of mortality among women. Aim of the Work The aim of this work is to assess and evaluate wide local excision technique as an oncoplastic procedure for management of breast carcinoma in the upper/upper lateral quadrant with matrix rotation technique regarding cosmetic, surgical outcomes, and patient satisfaction. Patients and Methods This prospective randomized controlled study included 30 patients separated into two groupings cancer breast scheduled for oncology breast surgery divided to two equal group: Group I: wide local excision technique. Group II: matrix rotation technique. Conclusion Wide local excision is a safe oncoplastic technique, causing significantly less post- operative hematoma, mild seroma, minimal blood loss, less areolar deviation and better breast symmetry than matrix rotation technique.

Pedicled Descending Branch Latissimus Dorsi Mini-Flap For Breast Reconstruction: Shoulder Functional and Aesthetic Outcomes

Abstract Background The cosmetic drawbacks of BCT are asymmetry, nipple or skin retraction, and volume loss which results in an unsatisfactory cosmetic outcome. Therefore, many volume replacement techniques were invented to counteract this. The commonest volume replacement technique for breast reconstruction is autologous LD flap in which skin paddle and subcutaneous tissue are harvested with the flap resulting in increased donor site morbidity. Objective To evaluate the latissimus dorsi mini-flap (LDMF) regarding the cosmetic outcomes and patient satisfaction. Moreover, it will evaluate procedure related complications and the benefit of using this procedure as a volume replacement to large breast defect after wide local excision in different breast quadrants excluding the lower inner quadrant (LIQ). Patients and Methods Our study was conducted on 15 patients to evaluate post-operative complications and patient satisfaction primarily. The results have demonstrated the safety of this procedure which is associated with a low rate of complications. Our study was designed to assess breast-sparing approaches using LD mini flap (LDMF) for reconstruction of the breast after wide local excision of large breast tumors that would result in otherwise unacceptable deformity. Results The LDMF generally is not a time-consuming technique as the average operative time was generally less than three hours. This time included the time for resection and the time waiting for frozen section results. The LDMF reconstruction was associated with considerable sensory preservation. This technique not only preserves most of the breast tissue but also, it spares us doing additional procedures such as nipple reconstruction. Avoidance the use of an implant is an additional advantage to the LDMF as this decrease the rate of infection and decrease the cost of the procedure. Conclusion LDMF volume replacement extends the role of breast-conserving surgery to a group of patients who are traditionally offered mastectomy. Despite the increasing use of Neoadjuvant chemotherapy, some patients have a disease that fails to respond or extensive DCIS and can, therefore, benefit from this oncoplastic technique. Frozen-section analysis of the tumor cavity is essential for surgical decision making. Our study had demonstrated the safety of this procedure which is associated with a low rate of complications. This technique has a high patient satisfaction rate wit agreeable cosmetic outcome. This technique can be used as a volume replacement to large breast defect in different breast quadrant except in lower inner quadrant which was not included in this study.

Assessment of Wide Local Excision in Patients with Multifocal Breast Cancer using Wire Clip Bracketing

Abstract Background Breast-conserving surgery, also known as BCS, is both oncologically and surgically safe and has a long term survival rate in comparison to modified radical mastectomy. BCS can be performed with a simple wide excision or with variant levels of oncoplastic surgical techniques. There are many factors that can affect aesthetic outcomes, these factors are either both patient-related or surgeon-related, however the volume of breast tissue that needs to be excised is the most important factor. Aim To assess the feasibility and the safety of wide local excision in patient that have multifocal breast cancer using wire clip bracketing. Patients and Methods The Population was female patients with multifocal breast cancer at Breast unit general surgery department, Ain shams university. Results The mean size of tumors were 2.2 ± 1.1 mm according to mastographic characteristics, There were 55.0% with Non-palpable masses, 45.0 % with Palpable. 40% Positive LNs, we had 100% free resection margins with least resection margin being 0.8 cm as we confirmed all margins intraoperative with frozen section, 13 patients (65%) got excellent degree of satisfaction with the post-operative cosmetic outcome of our surgical procedure, 4 patients (20%) got good degree and 3 patient (15%) got fair degree of satisfaction. Conclusion Wide local Excision using the wire bracketing technique leads to more optimal resection volumes for multifocal breast cancer without compromising margin status with good aesthetic outcomes.

Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study.

Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.

Enhanced disease-specific survival in lentigo maligna melanoma patients treated with Mohs surgery over wide local excision: A retrospective cohort analysis of the Surveillance, Epidemiology, and End Results database

Enhanced disease-specific survival in lentigo maligna melanoma patients treated with Mohs surgery over wide local excision: A retrospective cohort analysis of the Surveillance, Epidemiology, and End Results database

Independent Risk Factors for Postoperative Recurrence of Patients with Primary Extramammary Paget's Disease: A Retrospective Analysis.

Extramammary Paget's disease (EMPD) is a rare skin cancer with unclear pathogenesis, insidious progression, and high recurrence rate. The purpose of this study was to investigate the clinical features and postoperative recurrence factors of primary EMPD. We retrospectively analyzed the medical records of 40 patients with primary EMPD who underwent wide local excision surgery at a single medical center between 2009 and 2019. Risk factors for recurrence of primary EMPD were analyzed using multivariate binary logistic regression. The study included 40 patients with primary EMPD, comprising 31 males (77.5%) and 9 females (22.5%), with a median age of 75.52 years (range 52-99 years). The most common lesion location was the scrotum (22 cases, 55.0%), followed by the vulva, penis, scrotum, underarm and anus. Multivariable regression analysis revealed significant differences in the presence of ill-defined tumour borders, exudation and nodules in the primary lesion affecting the relapse of primary EMPD (p<0.05). Our findings indicate that ill-defined tumour borders, exudation and nodules in the primary site should be considered as independent risk factors for disease recurrence, which may provide useful suggestions for the diagnosis, treatment and follow-up of primary EMPD.

Large cell neuroendocrine carcinoma of oral cavity: A rare case report with review of literature

Abstract Neuroendocrine tumours (NETs) primarily affect the lungs and larynx. Primary neuroendocrine carcinomas (NECs) rarely occur in the oral cavity. The classification of these tumours is ambiguous; however, the literature acknowledges their aggressiveness. Merkel cell carcinoma (MCC) is rare and more common in the skin but could occur intraorally. MCC and NECs are aggressive neoplasms and recommend intensive treatment. In this case report, a 22-year-old female presented with an ulceroinfiltrative lesion in the left buccal mucosa of the cheek, which was diagnosed as primary NEC in the oral cavity. This patient underwent wide local lesion excision of oral cavity mass, ipsilateral selective neck node dissection of levels 1–4 and postoperative chemotherapy. This aggressive tumour type requires large local excisions with margins like Merkel cell skin carcinomas. To our knowledge, this is the youngest oral cavity primary neuroendocrine cancer patient to date in the literature.

Functional Outcome of Patients with Malignant Tumors around the Knee Treated by Modular Endoprosthesis: A Comparative Study between Patellar Resurfacing and Nonresurfacing

Abstract Background: Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis. Questions/Purposes: Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee? Patients and Methods: Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score. Results: We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337). Conclusions: Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.

Flexor Digitorum Superficialis to Flexor Digitorum Profundus Tendon Transfer after Wide Excision of Myxoinflammatory Fibroblastic Sarcoma: A Case Report

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare, low-grade soft tissue neoplasm that typically arises in the extremities. A 72-yearold woman presented with recurrent masses on her left forearm. Four years prior, she underwent an excisional biopsy, diagnosed as MIFS, followed by wide excision and split-thickness skin graft coverage. Preoperative magnetic resonance imaging was conducted for the recurrent mass, revealing multiple tumors invading the flexor digitorum profundus (FDP) muscle and fascia. The tumors including most of the FDP muscle were therefore excised. The third flexor digitorum superficialis (FDS) tendon was harvested, divided in half, and connected to the second and fifth FDP tendons. The same procedure was performed for the third and fourth FDP tendons with fourth FDS tendon. An anterolateral thigh free flap was used to reconstruct the skin and soft tissue defect of the left forearm. Adjuvant radiation therapy was performed. At 12 weeks postoperatively, the patient exhibited no wound complications and achieved spontaneous partial flexion of the metacarpophalangeal and proximal interphalangeal joints.

Subcutaneous Basal Cell Carcinoma arising from Surgical Drain Insertion Site: A Case Report

Basal cell carcinoma (BCC) is the most common type of skin cancer and primarily affects the sun-exposed areas of the body. It usually presents as visible skin lesions; cases of subcutaneous BCC without apparent skin involvement are extremely rare. Here, we present the case of an 81-year-old female who underwent hysterectomy for an ectopic pregnancy 50 years prior and presented with a subcutaneous mass in the lower abdomen that gradually increased in size over the previous 6 months. The mass only displayed a mild hypertrophic scar the color of skin at the site where a surgical drain had been inserted. Ultrasonography revealed a nonspecific soft tissue tumor, for which we recommended an ultrasound-guided biopsy. Histopathological analysis indicated the need to differentiate between BCC and trichoblastoma. Subsequent wide excision with a 5-mm margin confirmed the BCC diagnosis. This case highlights the challenges in diagnosing and managing subcutaneous BCC with unusual clinical symptoms.

Survival and Treatment Modalities in Primary Vaginal Melanoma-Case Report and a Narrative Review.

Background/Objectives: Primary vaginal melanoma (PVM) is a rare cancer representing five percent of vaginal cancers and less than one percent of all female vaginal melanomas, with an incidence rate of 0.46 per million women per year. The aim of this study was to present a case of combined therapy and conservative surgical treatment in a young patient with PVM and to perform a systematic review of the same subject. Methods: We performed a narrative review of the literature and presented a case report. Results: The review yielded a total of 43 articles. We presented treatment modalities and survival outcomes. The presented case involved a combination of surgical treatment with adjuvant therapy comprising nivolumab and ipilimumab. Conclusions: PVM is a disease with a poor prognosis; however, new treatment options are promising and have a great chance of significantly improving survival. The combination of the wide local excision of the primary lesion followed by adjuvant therapies results in the best outcomes in the treatment of PVM. Future clinical studies are warranted to provide new evidence for the treatment outcomes of nonsurgical, metastatic PVM and the adjuvant treatment of PVM.

Ameloblastic fibrosarcoma of the maxilla arising in an old woman, a rare case report and literature review

BackgroundAmeloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumor, commonly occurring in young adults and typically affecting the mandibular region. We report an exceptionally rare and highly atypical case of AFS in an elderly female patient originating from the maxillary bone.Case presentationA 66-year-old woman was admitted with a two-week history of a lump in her left upper molar. CT scans suggested a cyst in the maxillary bone. An incisional biopsy revealed a spindle cell neoplasm. MRI showed abnormalities in the left maxilla, indicating a possible tumorous lesion. The patient underwent a subtotal maxillectomy, wide tumor excision, intraoral epithelial flap transplantation, and dental extraction. Histology identified atypical tumor cells with visible mitotic figures. Immunohistochemistry showed negative for PCK and CD34 expression, but positive for Vimentin and SMA expression. The Ki-67 proliferation index ranged from 30 to 50%. These findings suggested a potentially malignant soft tissue tumor in the left maxilla, leaning towards a diagnosis of AFS. The patient received postoperative radiotherapy. There was no recurrence during the six-month follow-up.ConclusionBased on repeated pathological evidence, we report a rare case of an elderly female with AFS originating from the maxillary bone. Surgery and postoperative radiotherapy resulted in a favorable outcome.