[Malignant collision tumor of the skin : Melanoma, squamous cell carcinoma and basal cell carcinoma]. / Maligner Kollisionstumor der Haut : Melanom, kutanes Plattenepithelkarzinom und Basalzellkarzinom.

We present the case of a woman in her eighties with a collision tumor composed of a malignant melanoma, a squamous cell carcinoma and a basal cell carcinoma. The simultaneous growth of histogenetically different, spatially not separate, malignant tumors of the skin is rare. The classification is difficult and sometimes confusing, especially regarding the terminology used in the literature. The correct classification of such tumors has a high significance for the clinical daily routine.

Reconstruction of nasal defects with forehead flaps in patients older than 75 years of age.

BACKGROUND: As the number of elderly patients diagnosed with non-melanoma skin cancer (NMSC) increases, the number of patients receiving dermatologic surgery also increases. Multimorbidity in this patient group is common. OBJECTIVE: The aim of this study is to assess the aesthetic and functional outcomes and complications of forehead flap (FHF) in elderly patients with NMSC. METHODS: Between 2006 and 2011, data for 28 patients 75 years of age or older who had been treated with FHFs under tumescent local anaesthesia were analysed. RESULTS: The median age of the study participants was 81 years (range, 75-95 years). Of the 28 total patients, 16 (57%) were female and 12 (43%) were male. The average defect size was 11 cm(2) (5-30 cm(2)). Cartilage grafts were used in four patients (14%). The average time to takedown was 25 days (17-45). The median follow-up for the patients was 10 months (1-60 months). There were seven treatment-related complications due to infectious causes (2), epidermal necrotic tissue (2), bleeding (1), hair on the flap (1) and alar rim notching (1). No life-threatening complications were detected. CONCLUSIONS: The FHF procedure is a safe and low-risk procedure in patients 75 years of age or older with advanced skin defects. If a defect requires an FHF to obtain a normal and aesthetic appearance, this procedure should be performed. However, dermatologists must weigh the safety of the procedure in relation to the clinical benefits when managing this patient group.

Sex steroid hormones are not altered in great saphenous veins after varicose vein treatment in male patients.

OBJECTIVE: The objective of this study was to assess differences in blood samples (sex steroid hormone levels and blood counts) before and after surgical treatment of incompetent great saphenous veins (GSV) in males. METHODS: Antecubital vein and GSV blood samples were taken from 11 men with varicose veins and GSV reflux before and after treatment. Six patients were treated with high ligation, stripping and phlebectomy. Five patients were treated with endoluminal radiofrequency ablation and phlebectomy. After a four-year follow-up period (FU) cubital vein and GSV blood samples were taken again. RESULTS: In men with varicose veins, significantly higher (P < 0.05) serum testosterone (median 25.18 nmol/L, range 8.82-225.1) and oestradiol (median 179 pmol/L, range 79-941) levels were found in the saphenous vein samples before and after the FU (testosterone 18.8 nmol/L, range 7.96-83.1, oestradiol 171 pmol/L range 125-304) compared with the cubital vein samples before therapy (testosterone 15.72 nmol/L, range 8.36-23.29; oestradiol 84 pmol/L, range 41-147) and after the FU (testosterone 14.5 nmol/L, range 6.10-22.2, oestradiol 117 pmol/L, range 95-165). After the FU, one patient demonstrated recurrent varicose veins with groin neovascularization. Another presented with axial reflux of the anterior accessory saphenous vein. Further differences in blood counts and serum androstenedione levels between the upper and lower extremities were not detected. CONCLUSION: The differences between testosterone and oestradiol levels in the leg veins compared with the cubital veins persist after treating men with refluxing saphenous veins. These results suggest that local hormone regulation may be different between leg and arm veins in men with varicose veins.

New rhinophyma severity index and mid-term results following shave excision of rhinophyma.

BACKGROUND: Rhinophyma is a progressive nasal deformity resulting from hyperplasia of the sebaceous glands and connective tissue, with a negative effect on quality of life. Partial-thickness shave excision has been used for the treatment of rhinophyma, but the mid- and long-term efficacy of the treatment is unknown. OBJECTIVES: We analysed the clinical outcomes of shave excision in patients with rhinophyma in our centre between 2005 and 2009. METHODS: The entire nose was shaved using a scalpel while under tumescent anaesthesia. The clinical assessment was scored using a novel Rhinophyma Severity Index. RESULTS: Thirty-three patients with rhinophyma and shave excision were recruited for the study. A mid-term follow-up examination was possible in 23/33 (69.7%) patients. After a mean follow-up of 37.4 ± 13.2 months, 21 (91.3%) patients showed an improved Rhinophyma Severity Index (3.3 ± 1.1 to 1.7 ± 0.9, p < 0.0001). All patients reported a high level of satisfaction after surgery (excellent or good result). Eleven (47.8%) patients developed rhinophyma recurrence. CONCLUSION: Shave excision under tumescent anaesthesia is an effective treatment for rhinophyma. The treatment is associated with high patient satisfaction and minimal side effects. A possible recurrence of rhinophyma must be addressed, however, while obtaining informed consent.

No clinical benefit of preoperative fluorescence diagnosis of basal cell carcinoma localized in the H-zone of the face.

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignant skin carcinoma. Fluorescence diagnosis (FD) has been suggested as a promising method for noninvasive detection of subclinical tumour cell dissemination in BCC. OBJECTIVES: In this prospective study, we evaluated the clinical performance of a preoperative definition of the lateral borders of BCC by FD in comparison with its definition by purely clinical diagnosis (CD). The fluorescence intensity on the skin was recorded using a digital light-emitting diode-based fluorescence imaging system. METHODS: Twenty-six patients with BCC (22 with nodular subtype) of the H-zone were included. The tumour area was determined 3 h after application of methyl aminolaevulinate by inspection and photographic documentation (CD) and FD. Subsequently, BCCs were excised according to the complete area defined by CD and FD with a security margin of 3 mm; surgical specimens were sectioned horizontally and subjected to meticulous histological mapping. The tumour areas as determined by FD, CD and histology were superimposed to map the entire lateral tumour margin. RESULTS: The tumour area could be visualized by FD in 24 of 26 patients. The mean tumour area as determined by FD was significantly smaller than the tumour area as determined by CD [80 mm(2) , 95% confidence interval (CI) 50-110 mm(2) vs. 101 mm(2) , 95% CI 76-125 mm(2) ; P < 0·012]. The superimposition of FD and histology showed in 10 of 26 patients a complete detection of the tumour margin by FD; thus sensitivity of FD was calculated as 38·5%. In only three of 26 patients FD revealed a tumour extent greater than determined by CD. Specificity of FD was calculated as 88·4%. CONCLUSIONS: On aggregate, this study suggests that preoperative FD of nodular BCC localized in the H-zone offers no additional benefit to define subclinical tumour infiltration compared with CD alone.

Elevated serum estradiol/testosterone ratio in men with primary varicose veins compared with a healthy control group.

The role of sex hormones in men with varicose veins remains unclear. Therefore, we set up a prospective pilot-study. In 34 men, venous blood was sampled during morning hours, for the determination of serum estradiol (E2), dehydroepiandrostendion, androstendion, and free testosterone (fT). Serum E2:fT ratio was calculated. The study protocol also included patient history, physical examination, color duplex ultrasound of both limbs, and assignment of CEAP clinical stage (C) classification. About 21 symptomatic varicose men (VM [C > or = 2] mean age of 40.3/+6.9 years) and 13 healthy men (HM [C < or = 1] mean age of 38.1/+ 7.4 years) were analyzed. The serum E2:fT ratio (VM 2.83/+ 0.79 and HM 2.32/+0.63) was significantly different (P < .05) between the two groups. No major differences were seen on the serum levels of the sex hormones. In summary, our results demonstrate a changed serum E2:fT ratio among men with varicose veins compared to healthy men. By the fact of a small study sample, the interpretabillity of this result is limited.