Basal cell carcinoma (BCC) is the most common cutaneous malignancy, and the nasal tip is among the highest-risk sites for recurrence because of its complex three-dimensional anatomy and limited local tissue laxity. Tumor persistence after resection with positive margins mandates oncologic re-excision and individualized reconstructive planning. A 62-year-old woman with Fitzpatrick skin type II and a history of nasal-tip BCC excision with positive surgical margins presented with a 2.5 cm pearly, slow-growing neoformation arising over the previous scar, with a dermoscopic pattern consistent with recurrence. She was referred to plastic and reconstructive surgery, where a paramedian forehead flap was initially planned. Intraoperatively, after resection of a 2.8 × 2.2 cm defect, the surgical team opted instead for a local Rieger-type (rotation-advancement) flap with extension, achieving a tension-free, single-stage closure without the need for a regional flap. Definitive histopathology reported an infiltrative BCC with tumor-free margins. This case highlights the importance of coordinated care between dermatology and plastic surgery in managing recurrent nasal-tip BCC, and the value of intraoperative reassessment of the reconstructive plan according to the reconstructive-ladder principle, favoring the least complex technique capable of achieving a functional and aesthetically satisfactory result.
Colorectal cancer (CRC) is the second leading cause of cancer mortality worldwide. 90% of CRC-related deaths are due to metastasis. One of the rarer CRC metastases is bone metastasis, especially pelvic metastasis, with minor symptoms that frequently overlap with other degenerative diseases. The 85-year-old woman with CRC experienced progressive lower back pain radiating to both legs. CT scan showed degenerative spine disease. Further bone scan revealed lytic lesions on the superior pubic ramus, prompting a rare diagnosis of pelvic metastasis in CRC. The clinical symptoms exhibited by a late-onset CRC patient, consisting of lower back pain radiating to both legs, accidentally concealed the rare presence of pelvic metastasis. In this case, the bone metastasis was successfully diagnosed following a routine bone survey, underscoring the importance of this procedure. Delayed diagnosis plummets the median survival from 20-30 months to just 2-3 months; clinicians must be aware of minor skeletal symptoms and utilize early advanced imaging to avoid catastrophic diagnostic delays and poor treatment outcomes. This rare case of pelvic metastasis in a CRC patient highlights the importance of not undermining minor skeletal symptoms in CRC patients and thoroughly exploring the possible cause of symptoms to avoid underdiagnosis or delays in diagnosing rare metastasis that could potentially alter outcomes for the worse.
Background: Thyroid nodules are common in clinical practice and accurate preoperative differentiation between benign and malignant thyroid nodules is essential to avoid unnecessary surgery while ensuring timely management of malignancy. Ultrasonography (USG) and fine needle aspiration cytology (FNAC) are commonly used diagnostic tools, but their accuracy varies across clinical settings. To evaluate the diagnostic accuracy of USG and FNAC in thyroid swellings by comparing preoperative findings with final histopathological examination. Methods: This retrospective observational study included 190 patients with thyroid swellings who underwent thyroidectomy at a tertiary care centre between January 2015 and May 2022. Preoperative USG and FNAC findings were correlated with postoperative histopathology. Sensitivity, specificity and diagnostic accuracy of each modality were calculated. Results: Of the 190 patients screened, 187 with complete histopathological data were included in the final correlation analysis. Histopathology confirmed malignancy in 75 cases (40.1%) and benign disease in 112 cases (59.9%). When correlated with final histopathology, FNAC demonstrated sensitivity of 77.3%, specificity of 87.5% and diagnostic accuracy of 83.4% as compared to USG with sensitivity of 82.7%, specificity of 63.4% and diagnostic accuracy of 71.1%. Sonographic features such as taller-than-wide shape, solid composition and punctate echogenic foci showed significant association with malignancy (p<0.01). Conclusions: USG and FNAC are valuable complementary tools in evaluating thyroid swellings. FNAC is a highly specific and accurate diagnostic modality for thyroid swellings, while USG serves as an effective screening and risk stratification tool. Their combined use significantly improves diagnostic accuracy and helps reduce unnecessary thyroid surgery, although histopathology remains the definitive diagnostic modality.
Basal cell carcinoma (BCC) is the most common cutaneous malignancy and frequently affects sun-exposed facial regions. Lesions of the upper lip are considered high risk due to their tendency for local invasion, recurrence, and involvement of critical functional and aesthetic subunits. Optimal management requires complete oncologic excision followed by anatomically precise reconstruction. We report the case of a 66-year-old woman with a recurrent nodular BCC of the upper lip after prior incomplete excision. Margin-controlled surgical resection was performed with intraoperative frozen-section analysis. Persistent deep margin involvement required extension of the excision to include the upper lip, anterior nasal vestibule floor, and premaxillary periosteum, resulting in a defect involving approximately 40% of the upper lip. Immediate reconstruction was carried out using a layered anatomical approach, including separate repair of the mucosa and orbicularis oris muscle, bilateral perialar advancement flaps, and an additional local cutaneous flap to reconstruct the central tubercle. This case highlights the importance of achieving complete tumor clearance in recurrent BCC, particularly in high-risk anatomical regions such as the upper lip. Reconstructive planning must balance oncologic safety with restoration of oral competence, symmetry, and aesthetic subunits. Local advancement flaps, especially perialar techniques, represent reliable options for moderate defects (30–50%), providing good functional and cosmetic outcomes when combined with meticulous layered repair. The presence of recurrence and periosteal involvement underscores the need for multidisciplinary evaluation, including consideration of adjuvant therapies. Recurrent upper-lip BCC requires an integrated approach combining aggressive oncologic resection with tailored reconstruction. Layered repair and local advancement flaps allow effective restoration of both function and aesthetics in moderate-sized defects, supporting their role as first-line reconstructive options in appropriately selected cases.
Background: Mastalgia is the most common presentation to Breast Clinics, reassurance forms the first line of management. No studies have explored structured patient education in mastalgia till date. Methods: Patients with mastalgia for more than 1 month were randomized to structured patient education and reassurance group. The structured patient education format was designed by the principal investigator and validated by 3 subject experts. Both the groups were assessed with visual analog scale (VAS) for pain, 12-item short form health survey (SF-12) for quality of life and generalized anxiety disorder-7 scale (GAD-7) for anxiety at baseline, 4 and 12 weeks after intervention. The assessor was blinded. Results: A total of 64 patients were randomized equally into two groups. Both groups showed improvement in pain and anxiety scores over time. A statistically significant improvement in the SF-12 physical component summary (PCS) was observed in the structured education group at 12 weeks (p=0.032). Improvements in mental component summary (MCS) and GAD-7 anxiety scores were observed in both groups, but without statistically significant difference. Analgesic use decreased in both groups, with a trend toward greater reduction in the structured education group. Conclusions: Structured patient education improves the physical component of quality of life in women presenting with mastalgia and may contribute to better overall symptom control compared to routine reassurance alone. While both interventions reduce pain and anxiety, structured education provides a standardized and potentially more effective approach to patient counselling.
