BACKGROUND:Squamous cell carcinoma (SCC) is the second most prevalent cancer in the world with a worldwide increase of 310% from 1997 to 2017. The prognosis is usually good; however, metastases occur in up to 5% and are linked to high mortality rates. Even though the risk of metastasis and death is low, the mortality now exceeds that of melanoma. OBJECTIVE:We wanted to investigate the latest tendencies of SCC regarding recurrence and metastasis. METHODS:The study was a retrospective, single-centre, cohort study of patients in Central Denmark Region. The purpose was to evaluate all patients receiving surgery for SCC in 2018 and 2019. We evaluated all patients receiving the diagnostic code 'skin cancer' DC44XX. RESULTS:The cohort consisted of 781 patients with SCC. Of the 781 patients, 63 (8%) were recurrent tumours. Recurrent tumours were more likely to metastasise later. Of the 63 patients that had a recurrent tumour, 19 (30.2%) patients were primarily treated with curettage or cryotherapy. The remaining recurrent tumours were treated with surgical excision. Of these, 7 (11.1%) were treated with undisclosed margins and 8 (12.7%) with positive margins. Late locoregional metastases were present in 12 (1.6%) patients and six (0.8%) patients had locoregional metastases at the time of diagnosis. CONCLUSION:Our investigation showed the importance of wide negative excision margins when treating SCC. The higher prevalence of late locoregional metastases than locoregional metastases at diagnosis may suggest lymph node examination in routine controls after excision of SCC and better patient instructions regarding self-examination.

Introduction Necrotising soft tissue infection (NSTI) is an exceptionally dangerous infectious disease targeting soft tissues with high mortality as well as morbidity.The aim of reconstructive surgery after initial debridement is to maintain function as well as to achieve a satisfactory cosmetic result. Presentation of case A 50-year-old male presented with necrotising soft tissue infection on the thorax and left upper arm following mastectomy for breast cancer. He underwent aggressive debridement and was left with a large complicated soft tissue defect on the thorax, abdomen and left axilla with a wound bed consisting of exposed bone, nerves and vessels. There were close to no adjacent skin edges to fixate the flap, due to the size of the defect. Reconstruction with a free musculocutaneous latissimus dorsi (LD) and split skin grafting was performed. Vacuum therapy was applied immediately over the free flap and the vascular pedicle, as well as the skin graft. Discussion Application of NPWT to the entire reconstructed area, including the free flap, in terms of achieving better and faster healing, is somewhat novel. Applying negative pressure wound therapy (NPWT) on free flaps is not a new practice but it has mostly been used as incisional therapy or when complications have occurred. Conclusion Our case shows a successful microsurgical reconstruction in a challenging area, with the direct application of NPWT perioperatively, without compromising flap survival, and with good patient outcome.

Disturbances of the nail apparatus are common and mainly benign. This review aims to investigate the aetiology of these disturbances, which range from more common benign causes to less common melanomas. Melanonychia may be the most prominent concern and is characterised by brown or black nail plate discoloration. Hence, understanding the most common nail changes, their epidemiology, pathophysiology, and clinical features are imperative to diagnosis and may prevent unnecessary surgical procedures in cases where it is not warranted.

Benign skin tumours are commonly seen by general practitioners. They are important to differentiate from skin malignancies. Most benign skin lesions are diagnosed based on the history and clinical features. However, if the clinical diagnosis is uncertain, a skin biopsy, e.g. excisional or punch for histopathological examination is necessary to rule out malignancy. Seborrheic keratoses are the most common benign skin tumours with an increasing incidence with age. Other common benign skin lesions include melanocytic naevi, acrochordons and dermatofibromas, which may resemble malignant neoplasms.

Patients in immunosuppressive treatment may have increased risk of post-operative infections and wound-healing complications. Perioperative management of immunosuppressive treatment is challenging due to the variety of medications and differences in surgical procedures across surgical specialities. This review examines the literature regarding the effect of immunosuppressive treatment on post-operative infections and wound-healing complications.

It is unclear whether 12‐lead ECG employing standard criteria for left ventricular hypertrophy (LVH) provides similar information with respect to long‐term cardiovascular risk as echocardiography. The authors performed a retrospective cohort study of 1376 individuals without cardiovascular disease, who underwent ECG (LVH defined using the Sokolow‐Lyon voltage combination (>35 mm) or the Cornell voltage‐duration product (>2440 mm × ms)) and echocardiography (LVH defined as LV mass index (LVMI) >95 g/m2 for women and >115 g/m2 for men). The prognostic ability of LVH was assessed in Cox regression models adjusted for age, sex, smoking, systolic blood pressure, total cholesterol, antihypertensive medication, and fasting glucose. The primary end point was the composite of coronary events, heart failure, stroke, or death. The main secondary end point was heart failure or cardiovascular death. Median age was 67 (range 56‐79) years, 68% were male. Eleven percent had ECG‐defined LVH, 17% had echocardiographic LVH. Over median 8.5 years, 29% experienced a primary event. Event rates were 29%/35% for persons without/with ECG‐defined LVH and 27%/39% for those without/with echocardiographic LVH. The Sokolow‐Lyon combination, Cornell product, and ECG‐defined LVH did not significantly predict the primary end point (P ≥ .05), but ECG‐defined LVH predicted heart failure or cardiovascular death (adjusted hazard ratio (HR), 1.86, 95% confidence interval (CI), 1.13‐3.08); P = .02). Conversely, LVMI was a significant, independent predictor of the primary end point (adjusted HR, 1.87, 95% CI, 1.13‐3.10; P = .01), as was echocardiographic LVH (adjusted HR, 1.27, 95% CI, 1.01‐1.61; P = .04). Echocardiographic LVH may be a better predictor of long‐term cardiovascular risk than ECG‐defined LVH in middle‐aged and older individuals.

Penile melanomas are rare and approximately 200 cases exist in the literature, with a mean patient age of 67 years on presentation.1 Nevi on genitalia can prove a diagnostic challenge because of clinical, dermoscopic, and histologic similarities with malignant melanomas.2 When nevi are superimposed on lichen sclerosus in mucosal skin, the diagnostic difficulties are even greater and correct diagnoses requires histopathologic examination. Various opinions about the interpretation of melanocytic lesions associated with lichen sclerosus have been published, and only a few cases describe the association on male genitalia.

Patients diagnosed with quadruple synchronous primary cancers are extremely rare and we present here, to the best of our knowledge, the first case report of this combination of primary cancers. A 70-year-old woman was diagnosed with cervical adenocarcinoma, melanoma on the right leg, invasive ductal cell carcinoma metastasis in the left axilla with no primary breast tumour detected and multiple basal cell carcinomas on the limbs, all within 2months. The management was conducted in collaboration with six medical specialties. The cancers were surgically managed, with further adjuvant chemotherapy and ongoing hormone therapy for her breast cancer. Four years after the diagnosis, no signs of recurrence or further metastases from any of the cancers are present.

Massive, submassive, and nonmassive pulmonary embolism relate to the hemodynamic state, while saddle pulmonary embolus is a purely radiologic term. Patients with saddle embolus often present with hemodynamic compromise. However, treatment depends on the clinical presentation, and stable patients with a saddle pulmonary embolus can respond well to conventional anticoagulation.

This review discusses female genital mutilation (FGM), which is a culturally founded ritual of unknown origin. The definition is intentional altering or injuring the female genitals for non-medical reasons. The WHO estimates, that more than 200 million women have sequelae from FGM. Acute compli-ca-tions range from haemorrhage and infection to death, while the most common chronic complications are vulvar pain, problems with micturition and childbirth, recurrent infec-tions, dysmenorrhoea, and dyspareunia. Favourable surgical techniques are available. Hitherto, these techniques are limited to certain types of FGM.

Local anaesthetics are widely used in clinical practice. They comprise a group of weak organic bases, which selectively block sodium channels in the nerve cell membrane, thus blocking transmission of nociception by impeding depolarisation of the nerve. Local anaesthetics are generally safe and readily used and provide reduction of pain during biopsies, invasive procedures and surgery. This is an updated review of pharmacology and utilisation of local anaesthetics, as well as an overview of adjuvants, allergies, and adverse effects.

Local anaesthetics are widely used in clinical practice. They comprise a group of weak organic bases, which selectively block sodium channels in the nerve cell membrane, thus blocking transmission of nociception by impeding depolarisation of the nerve. Local anaesthetics are generally safe and readily used and provide reduction of pain during biopsies, invasive procedures and surgery. This is an updated review of pharmacology and utilisation of local anaesthetics, as well as an overview of adjuvants, allergies, and adverse effects.

På verdensplan er forekomsten af svær overvægt (fedme), defineret som et body mass index (BMI) ≥ 30 kg/m2, mere end fordoblet siden 1975 [1]. I Danmark lider 14% af den voksne befolkning af svær overvægt [2]. Tilstanden er en kendt risikofaktor for udvikling af type 2-diabetes [3], og det er derfor ikke overraskende, at prævalensen af type 2-diabetes ligeledes er stigende [4]. Den ugunstige udvikling medfører en tiltagende øget risiko for kardiovaskulær sygdom [5]. Fedmekirurgi kan inducere vægttab, remission af type 2-diabetes og potentielt set også remission af kardiovaskulære tilstande. Hensigten med denne artikel er at give læseren et overblik over den nyeste evidensbaserede viden om effekten af fedmekirurgi på diabetes og kardiovaskulære tilstande samt gennemgå de seneste retningslinjer og potentielt nye indikationer for fedmekirurgi.

Cosmetic tourism is defined as patient mobility across borders, typically constituted by patients seeking cosmetic surgery at lower costs abroad. The most common procedures are abdominoplasty, fat grafting and breast augmentation. Very little is known about the complication rates after cosmetic tourism, and there is a paucity of evidence in all aspects of cosmetic tourism. In this review, we focus on post-operative complications i.e. post-operative infections, in particular with rare microorganisms such as mycobacteria.

The worldwide incidence of obesity, defined as a BMI ≥ 30 kg/m2, has more than doubled during the past four decades. Bariatric/metabolic surgery provides the largest and most sustainable degree of weight loss. This review briefly summarises the emerging randomised evidence of the superiority of these procedures over conventional treatment, in achieving glycaemic control and inducing remission in patients with type 2 diabetes as well as the observational evidence suggesting improvements in the long-term risks of cardiovascular outcomes and mortality.