OBJECTIVE: Compare full-thickness skin grafts versus split-thickness skin grafts in scalp reconstruction.
METHODS: Retrospective chart review of patients who underwent scalp reconstruction with skin grafts performed at a single institution from 2011 to 2016.
METHODS: χ2 or Fisher exact tests were used to compare graft integration and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft success and complications were analyzed using multivariate logistic regression.
RESULTS: A hundred and twenty-five full-thickness and 93 split-thickness grafts were performed in 200 patients, including 68 defects (31.2%) with exposed calvarium. Full-thickness grafts required fewer average reconstructions (P = 0.002). A 92.8% of full-thickness grafts had complete graft integration compared with 78.5% of split-thickness grafts (P = 0.002). This difference was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P ≤ 0.001). Despite higher rates of minor debridement, full-thickness grafts had less postoperative bone exposure and wound breakdown than split-thickness grafts on intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression, and increased graft sizes were significant predictors of graft outcomes.
CONCLUSIONS: Skin grafts, especially full-thickness, provide a versatile, reliable, and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, full-thickness grafts can succeed when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation, and immunosuppression may result in decreased graft take and increased complications.
METHODS: 3b.

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Skin cancer treatment is a core aspect of dermatology that relies on accurate diagnosis and timely interventions. Teledermatology has emerged as a valuable asset across various stages of skin cancer care including triage, diagnosis, management, and surgical consultation. With the integration of traditional dermoscopy and store-and-forward technology, teledermatology facilitates the swift sharing of high-resolution images of suspicious skin lesions with consulting dermatologists all-over. Both live video conference and store-and-forward formats have played a pivotal role in bridging the care access gap between geographically isolated patients and dermatology providers. Notably, teledermatology demonstrates diagnostic accuracy rates that are often comparable to those achieved through traditional face-to-face consultations, underscoring its robust clinical utility. Technological advancements like artificial intelligence and reflectance confocal microscopy continue to enhance image quality and hold potential for increasing the diagnostic accuracy of virtual dermatologic care. While teledermatology serves as a valuable clinical tool for all patient populations including pediatric patients, it is not intended to fully replace in-person procedures like Mohs surgery and other necessary interventions. Nevertheless, its role in facilitating the evaluation of skin malignancies is gaining recognition within the dermatologic community and fostering high approval rates from patients due to its practicality and ability to provide timely access to specialized care.

Super giant basal cell carcinoma (SGBCC), defined as greater than 20 cm in diameter, is a rare oncological entity, with scarce literature. The authors conducted a review to characterize SGBCC, specifically with regards to age, sex predilection, risk factors, geographical location, body site, metastasis, and treatment. A systematic literature search was conducted from 1972 to 2023. All abstracts, studies, and citations were reviewed. The initial result showed 47 281 articles and were filtered down for human, skin, English language, and SGBCC. The authors identified 20 case reports for our analysis. The sample size was too small to conduct extensive statistical analysis. Majority of the cases were reported in North America and Europe. Males outnumbered almost females 2:1. The mean age was 61 years. The lesion was located on trunk in 16 out of 20 cases. In 13 out of 20 years, the lesion had been present for more than 10 years and 7 out of 20 cases reported metastasis. Several reports documented low socioeconomic status and poor mental health. Regarding treatment, 11 patients underwent surgery, radiation was utilized in 6 patients and immunotherapy (Vismodegib) in 4 patients. Although basal cell carcinoma (BCC) is known to have a favorable prognosis, SGBCC is highly aggressive with ability to metastasize. Our review reveals SGBCC is commonly diagnosed in males in their sixth decade, present for more than 10 years duration, risk factors include low socioeconomic status and poor mental health, commonly found on the trunk with a predilection for metastasis. The authors believe self-neglect is the likely etiology of the large size. Treatment options may be multimodal with a combination of surgery, radiation therapy or immunotherapy (Vismodegib).

Keratoacanthoma (KA) is a common, low-grade, rapidly growing cutaneous squamous cell carcinoma that presents as an enlarging crateriform nodule, which may spontaneously involute but rarely metastasizes. Immunosuppression, ultraviolet light, viral infection, surgical procedures, and trauma are associated with their development. Overall, tattoo-induced squamous cell neoplasms are infrequently described in the literature. Carcinogenesis is hypothesized to result from trauma caused by the tattooing procedure or a foreign body reaction to the pigment. However, the pathogenesis has not been clearly defined. While most commonly associated with red ink, to date, very few cases of KA forming within black, blue, or multicolored ink tattoos are reported. Herein, we describe a case of KA arising within areas of blue and black pigment in a decorative ink tattoo.

Cutaneous angiosarcoma is an aggressive tumor most commonly presenting on the head and neck. In this case report, we describe the presentation of sepsis secondary to an aggressive and rapidly expanding wound, located in a sun-protected area on the body, in a patient with multiple concurrent comorbidities. Treatment was tailored toward targeting the causative organisms, as well as identifying the histologic morphology of the pathologic legion. Histopathology and immunohistochemistry were used to confirm the diagnosis of cutaneous angiosarcoma, and the patient-centered decision surrounding palliative chemotherapy is outlined.

This case describes a unique presentation of a rare malignancy: giant melanoma. Due to the accessibility of healthcare in the United States, it is unusual for melanomas to grow to massive sizes without clinical intervention. In fact, an in-depth literature review elicited only a handful of similar cases. Giant malignant melanomas are typically defined by a cutoff size of no less than 10 cm in diameter. They often present with distant metastases and are highly invasive. Due to limited yet highly variable presentations, there is no standardized approach to treating this class of melanomas. We present a case with unique features not previously documented in similar cases that was ultimately treated with a novel approach.

Atypical fibroxanthoma (AFX) is a rare spindle cell proliferation arising from significant sun exposure. AFX often appears as a red papule, typically found in the head and neck region of elderly patients. Since there is no specificity in immunohistology, various stains differentiate AFX from other skin cancers. The stains include cluster of differentiation 68 (CD68), cluster of differentiation 163 (CD163), vimentin, cytokeratin epithelial (CKAE), and melanin. While local recurrence is common, AFX rarely metastasizes. Thus, the treatment options are complete surgical excision or micrographically oriented histographic surgery.

BACKGROUND: Non-graftable or composite defect reconstruction represents a major challenge to the reconstructive surgeon, with many wounds requiring local flap or free microvascular tissue transfer approaches. The recent advent of synthetic skin substitutes such as Biodegradable Temporizing Matrix (BTM) have revolutionized the management of complex defects including those caused by burns, trauma and infection, with low-morbidity and low-complexity surgery. However, limited data exist supporting their use in cancer reconstruction in Australia.
METHODS: We performed a prospective cohort study of patients undergoing cancer resection and reconstruction with BTM between February 2021 and February 2023 in our institution. Reported outcomes included matrix integration, infection, and return to theatre.
RESULTS: Twelve patients underwent reconstruction of primary or secondary defects following cancer resection during this period. Eight patients were male, four female, mean age at surgery was 70 years. Pathology resected included squamous cell carcinoma (SCC) and melanoma of the head and neck, sarcoma resection of the lower limb, and osteoradionecrosis (ORN) of the scalp. T-stage of primary tumours ranged from T2 to T4 and one in-transit metastasis of melanoma. Four patients were treated with radiotherapy, two of whom received postoperative radiotherapy (PORT) and two who received neoadjuvant radiotherapy, three additional patients had an intervention to a previously irradiated wound bed for recurrence or ORN. Overall matrix integration was 83% (10/12), with a 50% integration rate (2/4) observed in the post-radiotherapy group, requiring return to theatre for alternative reconstructive approaches.
CONCLUSIONS: We report our experience with a synthetic dermal matrix (BTM) in cancer reconstruction, the largest cohort of this type in the Australian literature. BTM represents an exciting reconstructive tool for the cancer reconstructive surgeon, with a high rate of success and low morbidity.

Leser-Trélat sign (LTS) is characterized as an eruptive display of multiple seborrheic keratoses (SKs) in association with malignancy. This case highlights the variable presentation of LTS secondary to melanoma. To our knowledge, this LTS pattern is the first case where the sign manifests as a subtle pattern secondary to melanoma. This stands in contrast to the five documented cases in the literature of LTS-melanoma, which exhibited distinctive and eruptive patterns. A 64-year-old Caucasian female presented for a wellness examination. No personal history of skin cancer was noted. Patient displayed an onset proliferation of SKs with an irregular, sub-centimeter macular nevus over her right lateral mid back. A 6mm punch biopsy was significant for melanoma in situ, arising within a lentiginous compound dysplastic nevus, focally abutting one peripheral tissue edge. A re-excision with a minimum of 5mm margins was completed and the specimen was negative for residual in situ melanoma. Because of the rare occurrence of this delicate pattern at the site of the melanoma, this presentation adds to the knowledge surrounding this diagnosis. This case emphasizes the importance of maintaining vigilance regarding skin manifestations associated with disease and highlights the critical importance of observation and identification of subtle physical exam findings.