Konstantinos Seretis

Intraoperative margin assessment in keratinocyte skin cancer: Evolving techniques and future directions

Calcinosis cutis is a challenging complication of autoimmune connective tissue diseases, particularly dermatomyositis, and is associated with significant morbidity. Current medical treatments often show limited and inconsistent effectiveness, highlighting the need to better define the role of alternative approaches. To present a case of extensive dermatomyositis-associated calcinosis successfully managed with surgical excision and flap reconstruction, and to systematically review the role of surgical management in autoimmune-related calcinosis. A case report is presented together with a literature review conducted according to PRISMA guidelines. PubMed, Scopus, DOAJ and the Cochrane Library were searched from inception to June 21, 2026 for studies reporting surgical management of calcinosis in autoimmune connective tissue diseases. A total of 13 case reports and 3 case series were identified, including predominantly female patients with a median age of 55.3 years. Surgical intervention was mainly performed in symptomatic cases, such as pain, infection, or functional impairment. Overall, surgery was associated with pain relief and functional improvement, although recurrence and complications, including wound healing issues, were reported. Pharmacological therapies demonstrated variable and generally limited efficacy. Data on reconstructive techniques were scarce; however, available evidence suggests that flap reconstruction and grafting may improve outcomes in complex cases. Surgical management may represent a valuable treatment option for selected patients with calcinosis associated with autoimmune diseases, particularly in refractory or symptomatic cases. Reconstructive techniques may further enhance functional outcomes, although evidence remains limited. An individualized, multidisciplinary approach is recommended, and further studies are needed to establish optimal management strategies. Registration PROSPERO (CRD420261359925).

Chronic lower‐extremity ulcers remain a major therapeutic challenge. Conventional treatments—including compression therapy, debridement, dressings, antibiotics, pharmacologic agents, hyperbaric oxygen, and skin grafting—frequently fail to provide durable closure, largely due to limited modulation of the wound‐healing cascade. Autologous platelet‐rich plasma (PRP) is gaining interest as a regenerative adjunct capable of delivering concentrated endogenous growth factors. We report a 58‐year‐old woman with more than 20 previous skin grafting procedures for recurrent lower‐leg ulcers, arising from self‐inflicted trauma and secondary infections. Multidisciplinary care of a 15 cm × 18 cm ulcer incorporating debridement, targeted antibiotics, and mainly PRP, administered in six sessions, contributed substantially to ulcer reduction and finally to complete wound healing. PRP has shown promise in enhancing wound closure rates, healing time, and tissue quality. However, the absence of standardized protocols for preparation, dosing, and application, as well as inconsistent outcome reporting, limits its broader adoption. This case underscores the potential role of PRP as a central component in managing complex, refractory ulcers, particularly when behavioural and infectious factors impede healing. Standardized protocols and robust clinical trials are warranted to clarify its role in chronic wound care.

Background/Objectives: Fournier’s Gangrene (FG) is a severe and potentially fatal necrotizing infection of the perianal and genital regions, which necessitates prompt therapeutic interventions to prevent disease progression. Accruing evidence from recent research indicates that the neutrophil‒to-lymphocyte ratio (NLR) can predict clinical severity and mortality risk in patients with critical illnesses across various etiologies. This meta-analysis aimed to assess the efficacy of NLR as a prognostic indicator for mortality in patients with FG. Methods: An electronic literature search was conducted across several databases from their inception to 31 May 2024, following a predetermined protocol. Study quality was evaluated using the Cochrane risk of bias tool. A random-effect model was utilized to synthesize the available data. Results: Twelve studies reporting on 767 patients were included in the meta-analysis. Higher NLR levels at presentation were recorded in non-survivors than in survivors (MD = 4.49 [95% CI: 0.67–8.32]; p = 0.02). A 76% increased mortality risk was detected for patients with an NLR ≥ 8 (1.76 RR [1.35–2.3], p = 0.0001), and the mortality risk was more than twofold greater for patients with an NLR ≥ 10 compared to the remaining patients (RR = 2.31 [1.27–4.21], p = 0.006). All included studies exhibited a moderate to serious risk of bias. Conclusions: This meta-analysis reveals that the NLR represents a promising biomarker that can serve as a prognostic indicator in patients with FG. Future studies should address the establishment of proper disease-specific cutoff values to aid in clinical decision-making.

Background/Objectives: Scalp defect reconstruction often poses a challenge due to the distinct anatomy and limited skin elasticity of the region. Rotational flaps, when properly planned, offer a superior and creative solution for effectively covering most scalp defects. The aim of this study is to present the indications, and versatile use of rotational flaps in scalp reconstructive surgery, guided by an algorithmic approach and exemplified by numerous clinical applications. Methods: An observational cohort study was conducted between 2019 and 2024. The study protocol adhered to the ethical guidelines of the Declaration of Helsinki, was approved by the local ethics committee, and followed the STROBE statement for cohort studies. Results: A total of 152 rotational flaps were performed in 138 patients to reconstruct scalp defects, mostly following skin cancer excision. The defect size ranged from 30 to 96 mm in largest diameter (mean diameter, 52.8 ± 8.8 mm). Postoperative complications occurred in 13 cases (9.4%), and 5 cases (3.6%) required further surgical treatment, due to wound healing problems and/or necrosis. Based on high VAS scores (9.4 + 0.3), the cosmetic outcomes were deemed satisfactory, with excellent color and texture matching. Conclusions: This study underscores the critical role of meticulous surgical planning and technique in achieving optimal outcomes in scalp reconstruction. By combining the principles of tissue biomechanics with the versatility of rotational flaps, surgeons can effectively address a wide range of defects, achieving both functional and esthetic excellence.

Background. Complete basal cell carcinoma (BCC) excision remains the most common treatment modality. However, its clinical characteristics and the surgical outcomes achieved in patients over 80 years—often with several medical comorbidities and potentially limited life expectancy—have not been thoroughly examined. This clinical study aims to investigate tumor-specific characteristics and surgical outcomes following surgical treatment of BCC in older individuals. Methods. An observational cohort study based on a prospectively maintained database was conducted in a tertiary center using a predetermined protocol. Patients who underwent BCC surgery between January 2010 and September 2024 were included and grouped by age under or over 80 years. The inclusion criterion was a histologically confirmed BCC, while patients with syndromes predisposing BCC development were excluded. Results. Among the 1396 biopsy-proven BCCs, 35% of the patients were older than 80 years. No significant differences were observed in their baseline characteristics. The pathogenic capacity was greater in elderly patients, who exhibited higher rates of multiple and concurrent skin cancers, larger BCC diameters, and routine involvement in high-risk areas. More lesions were classified as high-risk for recurrence, and the surgical treatment was accompanied by a higher frequency of positive or close margins, high-grade subtypes, and perineural invasion. Logistic regression of 1150 BCCs revealed that age > 80, advanced TNM stage, and margin status robustly predict high-risk histology and high NCCN risk of tumor recurrence. Conclusions. This study highlights that BCC in the elderly population tends to present with a more aggressive tumor status, based on the key clinical and pathology features. These findings underscore the need for tailored surgical strategies in this population.

The cornerstones of forehead reconstruction are the provision of adequate skin paired with a satisfactory cosmetic outcome without hairline and eyebrows distortion. Several techniques have been described over the years to reconstruct sizable defects. Currently, an individualized approach, based on the patient’s medical status and needs, the defect characteristics, and the local tissue quality and availability, should be considered for an optimal outcome. This case exemplifies the reliability of local flaps’ combination to reconstruct concurrently 3 adjacent forehead defects, should innovative thinking and adequate planning be applied.