Recurrent occipital dermatofibrosarcoma protuberans tackled with wide local excision: A case report and current management

@#Dermatofibrosarcoma protuberans (DFSP) is a slowgrowing, locally invasive tumour of the dermis. It commonly presents in the trunks and proximal extremities but is seen to a lesser extent in the head and neck regions. We present a case report of a recurrent DFSP in a 48-year-old Iban woman at the occipital region. The patient underwent wide local excision and removal of outer table of cranium, dressing followed by split thickness skin graft. Histopathological examination confirmed dermatofibrosarcoma protuberans with clear lateral surgical margins and a deep margin of 0.5mm. She is currently undergoing radiotherapy and is planned for 50Grey 25cycles.

Pilot study comparing steroid-impregnated and nonsteroid-impregnated absorbable nasal dressing following endoscopic sinus surgery

Introduction: Endoscopic sinus surgery (ESS) is themainstay for treatment of chronic rhinosinusitis versusmaximal medical therapy. We propose a more economicaloption, by using steroid-impregnated Gelfoam instead ofNasopore post ESS, as it is less expensive and has showedeffectiveness in preventing post-operative bleeding.Materials and methods: A randomised, double-blinded,placebo-controlled trial was carried out in eight patients with chronic rhinosinusitis or nasal polyposis who were planned for bilateral endoscopic sinus surgery. A Peri-operative Sinus Endoscopy (POSE) Score and Lund-KennedyEndoscopic Score (LKES) were recorded. The use ofhydrocortisone-impregnated Gelfoam dressing versusnormal saline-impregnated Gelfoam dressing werecompared. Scores were repeated post-operatively at oneweek, three weeks and three months interval.Results: For LKES, at the end of three months, 50% of thepatients had the same score difference, 37.5% had betterresults on the study side while 12.5% had better results onthe control side. Meanwhile, for POSE Score, at the end ofthree months, 75% of the patients had better scoredifference on the study side while 12.5% had better resultson the control side.Conclusion: Gelfoam can be used as nasal packing materialto deliver topical steroid after endoscopic sinus surgery.Steroid-impregnated nasal dressing after endoscopic sinussurgery may not provide better long-term outcome.