Pilomatrix Carcinoma: A Benign-Mimic with Malignant Consequences - A Case Report and Review of the Current Literature.

Introduction: Pilomatrix carcinomas (PMXCs) are uncommon, locally aggressive tumors with high recurrence rates, metastatic potential, and fewer than 130 cases reported in the literature. Typically, they present as an unassuming, firm, dermal swelling and therefore are frequently mistaken for more common, benign masses, leading to undertreatment which can cause local invasion and metastatic spread. Diagnosis relies on excision with pathologic analysis; however once diagnosed, there are no current recommendations to guide treatment or surveillance for recurrence or metastases. Case Presentation: Here, we present a case of one of these rare tumors. Our case describes a 1.5 × 2.5 cm firm, mobile mass at the supraorbital rim in an otherwise healthy, young patient. Prior to removal, we suspected a benign pathology; however, excision proved difficult and pathologic diagnosis was consistent with PMXC. Following discussion with tumor board, decision was made to perform Mohs micrographic surgery and staging via CT scans with regular follow-up and surveillance scans. Conclusion: PMXCs are exceedingly rare diagnoses and present like many benign lesions. Therefore, we elected to document this case to encourage providers to keep these biologically aggressive tumors on their list of differential diagnoses in an unsuspecting mass, as well as to provide our own recommendations for treatment and screening for recurrence and metastatic spread.

Cheek Donor Site for Full-Thickness Skin Graft Repair of the Nasal Ala: Outcomes of a Retrospective Cohort Study.

BACKGROUND: Full-thickness skin grafts (FTSGs) are useful repairs for reconstructing nasal alar defects. Traditional donor sites include the preauricular, postauricular, and supraclavicular skin. OBJECTIVE: To evaluate esthetic outcomes and complications of nasal alar defects repaired with FTSGs from the medial cheek. MATERIALS AND METHODS: A retrospective chart review of Mohs surgery patients who had FTSG repair of the nasal ala between January 2015 and August 2020 was performed. Demographic, surgery, and follow-up visit data were reviewed. Cosmesis was rated by a facial plastic surgeon, a Mohs surgeon, and a plastic surgeon using baseline, defect, and follow-up visit photographs. RESULTS: Sixty-nine patients with FTSG repairs of nasal alar defects were identified. 51 of 69 patients (73.9%) had the cheek donor site, and 18 of 69 patients (26.1%) had a noncheek donor site. The mean (SD) rater visual analog score for both cohorts was good with no significant difference (cheek: 65.9 [13.8]; noncheek: 66.1 [15.3]; p = .96). A notable difference in the complication rate by donor site was observed (cheek: 6.9%, noncheek: 16.7%; p = .13), although it did not reach significance. CONCLUSION: The cheek is a reliable FTSG donor site for nasal alar defects after Mohs micrographic surgery, with a trend toward fewer complications.

Desmoplastic fibroma of the hand: case report.

Desmoplastic fibroma is a benign tumor of the soft tissue and rarely of the bone. It typically presents in the trunk and proximal limbs, but it is quite rare in the hands. We present a rare case of desmoplastic fibroma of the soft tissues of the hand that presented as a slow-growing, painless, well-encapsulated mass.

Early management of the mangled upper extremity.

Mangling injuries to the upper extremity can be devastating, and the early management of these injuries is critical for the success of the reconstruction. These are universally high energy injuries that will need to be taken to the operating room for effective management. Evaluation begins in the emergency department with assessment of vascularity, categorization of damaged structures and assessment of salvageability. There is no role for conservative treatment of these wounds, and once in the operating room, restoration of blood supply and adequate debridement are critical to the ultimate outcome. Removal of damaged, contaminated and devitalized tissues must occur. The goal of early treatment is to create a clean wound ready for reconstruction as soon as possible. Inadequate debridement will only delay reconstruction to the detriment of the patient.

Hand fractures and their management: an international view.

Fractures of the bones of the hand are among the commonest fractures in humans, but their management varies widely in the different regions of the world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Developing countries are more likely to apply less expensive methods of managing hand fractures. The treatment of these injuries will fall somewhere along a continuum that parallels the historical development of hand fracture management. This paper will review the history of phalangeal and metacarpal fracture management to infer global differences in the treatment of hand fractures. An overview of how different health care systems are likely to manage these injuries will assist health care providers in choosing the most appropriate treatment method.