Matteo Scampa

Background/Objectives: Calcinosis cutis universalis is a rare and severe manifestation of dystrophic calcification, most associated with connective tissue diseases such as dermatomyositis, systemic sclerosis, and systemic lupus erythematosus. It is characterized by widespread deposition of calcium salts throughout the soft tissues, leading to pain, recurrent infections, restricted mobility, and significant impairment in daily functioning and quality of life. Management remains challenging due to the absence of standardized treatment guidelines with risks including delayed wound healing and recurrence. Adjunctive therapies may support symptom control in refractory cases. Conclusions: Management of calcinosis cutis universalis requires an individualized, multimodal strategy. Based on available evidence and expert opinion, a stepwise therapeutic decision-making algorithm integrating medical, minimally invasive, and surgical approaches is proposed to guide clinical practice and the variable efficacy of available therapies. This review aims to summarize current therapeutic strategies and to propose a pragmatic approach to clinical decision-making. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar. The review focused primarily on calcinosis cutis universalis and severe or extensive forms of calcinosis cutis, with particular emphasis on surgical management and its integration with medical and minimally invasive treatments. Results: Pharmacological treatments—including bisphosphonates, calcium-channel blockers, tetracyclines, phosphate binders, probenecid, immunomodulatory agents, biologics, colchicine, sodium thiosulfate and JAK inhibitors—show heterogeneous and often partial efficacy, with more favorable responses in early or localized disease. Surgical interventions such as excision, curettage, CO₂ laser ablation, and reconstructive procedures provide meaningful symptomatic relief in selected patients but are associated.

Introduction: Chronic seroma and pseudomeningocele formation following spinal instrumentation, particularly in the setting of prior infection and multiple revision surgeries, remains rare but pose a significant therapeutic challenge due to high recurrence rate. In this context, we present a complex case of pseudomeningocele that evolved into a persistent seroma with cutaneous fistula after multi-level lumbar fusion with a comprehensive review of sclerotherapy protocols. Materials and methods: A 75-year-old patient with prior L3-S1 fusion surgery presented with rod fracture and underwent surgical revision. Postoperatively, a collection with purulent discharge and altered consciousness raised suspicion of a dural breach, later confirmed by Beta-Trace protein testing. Despite multiple revisions and placement of a pedicled SGAP flap, persistent pseudomeningocele developed, evolving in a chronic seroma after CSF leak resolution. The course was further complicated with chronic Staphylococcus Epidermidis infection. Revision surgery with flap mobilization and capsulectomy failed to resolve the seroma. Due to limited surgical options, a multi-instillation doxycycline sclerotherapy protocol via radiologically guided drain was initiated. Results: The sclerotherapy protocol resulted in progressive decrease in drain output, ultimately allowing for drain removal after 34 days. Follow-up ultrasound 7 days and 3 months after drain removal showed no significant fluid collection. No recurrence of fistula or seroma was observed during follow-up. Conclusion: This case highlights the challenges of managing postoperative wound complications in spinal surgery, particularly in the context of prior infection, hardware exposure, and suspected cerebrospinal fluid leak. A pedicled SGAP flap provided durable coverage, and doxycycline sclerotherapy proved an effective salvage treatment for persistent seroma after unsuccessful surgical revision.

Background/Aim: Cutaneous melanoma of the lip (LM) is a rare malignancy with a low overall survival (OS). Few studies exist in the literature to aid its diagnosis and treatment. The purpose of this study was to assess the different treatment modalities by collecting cases from a single database and to provide current information on the epidemiologic characteristics of cutaneous lip melanoma. Patients and Methods: The SEER database was searched for demographic, clinical-pathological, and therapeutic characteristics. The Kaplan-Meier model was used to analyze the overall survival (OS) of the study population, and survival curves were modelled. Univariable analysis between subgroups was carried out using the log-rank test. Surgery was further assessed with a multivariable cox regression, where the surgical procedure was adjusted for Breslow thickness. Results: Patients aged 62.4 years on average, and 62.7% of them were males. A total of 386 melanomas of the cutaneous lip were identified. Mean OS was 155.1 months, median OS was 187 months, and 67.4% had localized disease. Conclusion: LM has a poor prognosis with a 5-year OS of 75.2%. Surgery remains the mainstay of treatment, with less invasive surgical approaches yielding a comparable overall survival to surgery with greater margins.