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PURPOSE: Despite impressive response rates following adoptive transfer of autologous tumor-infiltrating lymphocytes (TILs) in patients with metastatic melanoma, improvement is needed to increase the efficacy and broaden the applicability of this treatment. We evaluated the use of vemurafenib, a small-molecule BRAF inhibitor with immunomodulatory properties, as priming before TIL harvest and adoptive T cell therapy in a phase I/II clinical trial. METHODS: 12 patients were treated with vemurafenib for 7 days before tumor excision and during the following weeks until TIL infusion. TILs were grown from tumor fragments, expanded in vitro and reinfused to the patient preceded by a lymphodepleting chemotherapy regimen and followed by interleukin-2 infusion. Extensive immune monitoring, tumor profiling and T cell receptor sequencing were performed. RESULTS: No unexpected toxicity was observed, and treatment was well tolerated. Of 12 patients, 1 achieved a complete response, 8 achieved partial response and 3 achieved stable disease. A PR and the CR are ongoing for 23 and 43 months, respectively. In vitro anti-tumor reactivity was found in TILs from 10 patients, including all patients achieving objective response. Serum and tumor biomarker analyses indicate that baseline cytokine levels and the number of T cell clones may predict response to TIL therapy. Further, TCR sequencing suggested skewing of TCR repertoire during in vitro expansion, promoting certain low frequency clonotypes. CONCLUSIONS: Priming with vemurafenib before infusion of TILs was safe and feasible, and induced objective clinical responses in this cohort of patients with checkpoint inhibitor-resistant metastatic melanoma. In this trial, vemurafenib treatment seemed to decrease attrition and could be considered to bridge the waiting time while TILs are prepared.

Breast cancer is the most common cancer diagnosed in women, and early stages are treated with lumpectomy and irradiation. Irradiation, however, leads to reduced vascularization and fibrosis, which may influence the cosmetic outcome unfavourably and increase complications after subsequent surgery on irradiated breasts. Patients with significant asymmetry after treatment may desire corrective reduction mammoplasty or mastopexy, but this may be associated with increased complication rates. This systematic review and meta-analysis aimed to investigate postoperative complication rates after bilateral reduction mammoplasty or mastopexy in women who had undergone unilateral lumpectomy and irradiation. PubMed, Medline, EMBASE and Cochrane databases were searched for eligible studies. After screening titles and abstracts, 14 full text studies were reviewed, and 7 of these were included in the analysis. The meta-analysis showed a significantly higher complication rate in the irradiated breast compared to the non-irradiated breast, rate ratio 4.82 (95% CI: 1.58, 14.70), p = 0.006. The complication rate was 54% in the irradiated breast (58/107) compared to 8% (9/107) in the non-irradiated breast (p = 0.034). This study suggests that reduction mammoplasty or mastopexy in the previously irradiated breast is associated with a significantly increased risk of complications. Careful patient selection and information are paramount in the treatment of this patient group.

Radiation is considered to be a risk factor for developing capsular contracture in augmented women, but the studies reporting on this subject show conflicting results. In this systematic review we sought to understand the risk of capsular contracture in augmented patients with breast cancer treated with breast conserving surgery and radiotherapy. A search was conducted through PubMed for studies reporting on breast cancer, breast augmentation and radiotherapy, with capsular contracture as our primary outcome. To determine if specific risk factors were significant predictors of the development of capsular contracture, we performed uni- and multivariate analysis. Our search revealed 136 articles, of which 12 were deemed eligible. A total of 237 patients were included in the analysis. Univariate analysis revealed that whole breast irradiation (WBI) was significantly associated with a higher risk of contracture (p <.001), compared to treatment with accelerated partial breast irradiation (APBI). A higher radiotherapy dose regimen was also significantly associated with a risk of capsular contracture (p <.001). When performing the multivariate analysis only the effect of increasing radiation dose remained significant (p <.05). Neither the implant location nor the age of the implant had any significant effect on the development of contracture. In conclusion this review shows that WBI is associated with a higher risk of contracture compared to treatment with APBI. Because of the limitations of the studies included, further studies with larger patient cohorts are needed to establish this correlation and evaluate other potential risk factors.

In this case report, two patients with metastases from melanoma after a disease-free period of 34 years are presented. In 1983, both patients were treated for melanoma on the lower extremity with wide local excision. In 2017, they experienced unnecessary waiting time and examinations before being diagnosed. A follow-up time of many years for all melanoma patients may not be feasible, however, both patients and physicians must be aware of the potential for late metastases. In the case of new tumours of unknown origin we suggest a diagnostic approach: once melanoma, always melanoma, until the opposite has been proven.

Facial nerve paresis is a known complication to surgery in the facial region. Spontaneous regeneration of such injuries has been described, but little is known about the prognosis and optimal management. This is a case report of two patients with partial facial nerve paresis following surgery. The patients were treated conservatively. Both experienced a regeneration over ten months post-operatively. This suggests a favourable prognosis with conservative treatment in selected cases, which is reassuring for both doctors and patients.

BACKGROUND: Closure of skin defects after scalp surgery may be accomplished by grafting; either split- or full-thickness. Both methods are used in Denmark, and the optimal approach on scalp defects without exposed bone is not known. This study aimed to investigate if the two methods were equal regarding graft take as primary outcome and as secondary outcomes complications and number of outpatient visits/ number of days from surgery until the last outpatient visit for the recipient site (as a proxy for time to healing), hypothesizing that they were.METHODS: The present retrospective single-center case series reported our experience using the two types of skin grafts after scalp surgery in the inclusion period from 1.1.2014 to 30.09.2015. Data were analyzed according to graft type with a full-thickness skin graft (FTSG-group) or a split-thickness skin graft (STSG-group).RESULTS: In the inclusion period, 106 patients had surgery (28 with a FTSG and 78 with a STSG). Irrespectively of which skin graft that was used, we found no statistically significant difference regarding percentage of adherence, complications or number of outpatient visits and time from operation until last outpatient visit regarding the recipient site (p>0.05).CONCLUSION: Our findings supported that use of either FTSG or STSG in scalp lesions were equal choices.

The review summarises the handling of open abdomen with fistula, which is one of the most serious complications in connection with abdominal surgery. Most often, morbidity and mortality are caused by lack of fistula control and multi-organ dysfunction. The primary aim is to prevent sepsis, control the fistula and optimise the patient's physiology. Vacuum-assisted closure treatment combined with a creative approach is recommended and increases the possibility of closure of the abdominal wall. Plastic surgical assistance is usually required. As the frequency of the condition is low, and as it is difficult to handle, treatment should be performed in specialised centres.

INTRODUCTION: This article explores variation in survival and mortality of Danish melanoma patients from 2012 to 2017 in relation to their region of residence and socioeconomic status.METHODS: Data were extracted from The Danish Melanoma Database, a clinical register, based on reports from hospital departments and dermatologists, and designed for quality improvement. The analysis included covariates at the person and tumour level. A cohort analysis was implemented to quantify the variations and identify the underlying mechanisms behind regional and socioeconomic variations in mortality of melanoma patients.RESULTS: The mortality of melanoma patients varied between the five regions with mean hazard ratios (95% confidence interval) of 1.36 (1.07-1.74) in men and 1.44 (1.08-1.92) in women between the regions with highest and lowest mortality. Mortality was highest in the patients with the lowest income and shortest education. Regional variation in mortality was attributable to underlying variation in tumour stage and thickness, and it was not confounded by other covariates.CONCLUSIONS: The two regions with the lowest mortality (highest survival) had high absolute incidence rates of stage IA and thin melanomas, indicating a high level of diagnostic activity in these regions. There was no regional variation in the incidence of advanced melanoma. The optimal level of diagnostic investigation of skin lesions has yet to be established.FUNDING: none.TRIAL REGISTRATION: not relevant.

Peripheral nerve injury can result in significant morbidity. The gold-standard treatment is currently end-to-end suture and is possible by mobilisation of nerve ends in cases with segmental nerve loss up to 1 cm. In cases of defects above 1 cm nerve autograft is the gold-standard treatment. To avoid donor site morbidity alternative procedures can be used, including conduits, nerve transfers and end-to-side suture. The purpose of this review is to create an overview of the currently available treatments of peripheral nerve injury and the clinical management of patients.

BACKGROUND: Radical inguinal lymphadenectomy (ILND) for metastatic melanoma is associated with a high complication rate. Seroma is often the first postoperative complication, followed by prolonged wound healing sometimes requiring reoperation, infection, multiple outpatient visits and re-hospitalization. Prevention of seroma may, therefore, lead to a reduction in many of the other complications.METHODS/DESIGN: The primary aim of this randomized study is to investigate whether fewer patients require treatment for seroma by immediate prophylactic application of incisional, Negative-pressure Wound Therapy (iNPWT) following ILND, compared to standard postoperative treatment. The secondary outcomes include surgical-site infection, dehiscence, hematoma, length of hospitalization, quality of life, safety, long-term assessment of lymphedema and non-inferiority oncological outcome. Data will be registered prospectively at check-ups after 7 and 14 days, 1 and 3 months and 2 years after inguinal lymphadenectomy using case report forms and questionnaires and stored in a secure online database.DISCUSSION: To our knowledge, this trial is the first randomized study evaluating negative-pressure wound therapy as a prophylactic intervention for complications following melanoma-related ILND. The results from this trial will hopefully determine the efficacy and safety of prophylactic iNPWT treatment in prevention of the clinical relevant short- and long-term postoperative complications following ILND and may provide an evidence base for the an improved postoperative regimen.TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03433937 . Prospectively registered on 15 February 2018.

Background: The nationwide Danish Cancer Registry and the Danish Melanoma Database both record data on melanoma for purposes of monitoring, quality assurance, and research. However, the data quality of the Cancer Registry and the Melanoma Database has not been formally evaluated. Methods: We estimated the positive predictive value (PPV) of melanoma diagnosis for random samples of 200 patients from the Cancer Registry (n = 200) and the Melanoma Database (n = 200) during 2004-2014, using the Danish Pathology Registry as "gold standard" reference. We further validated tumor characteristics in the Cancer Registry and the Melanoma Database. Additionally, we estimated the PPV of in situ melanoma diagnoses in the Melanoma Database, and the sensitivity of melanoma diagnoses in 2004-2014. Results: The PPVs of melanoma in the Cancer Registry and the Melanoma Database were 97% (95% CI = 94, 99) and 100%. The sensitivity was 90% in the Cancer Registry and 77% in the Melanoma Database. The PPV of in situ melanomas in the Melanoma Database was 97% and the sensitivity was 56%. In the Melanoma Database, we observed PPVs of ulceration of 75% and Breslow thickness of 96%. The PPV of histologic subtypes varied between 87% and 100% in the Cancer Registry and 93% and 100% in the Melanoma Database. The PPVs for anatomical localization were 83%-95% in the Cancer Registry and 93%-100% in the Melanoma Database. Conclusions: The data quality in both the Cancer Registry and the Melanoma Database is high, supporting their use in epidemiologic studies.

Background: Socioeconomic differences in survival after melanoma may be due to late diagnosis of the disadvantaged patients. The aim of the study was to examine the association between educational level, disposable income, cohabitating status and region of residence with stage at diagnosis of melanoma, including adjustment for comorbidity and tumor type. Methods: From The Danish Melanoma Database, we identified 10,158 patients diagnosed with their first invasive melanoma during 2008–2014 and obtained information on stage, localization, histology, thickness and ulceration. Sociodemographic information was retrieved from registers of Statistics Denmark and data on comorbidity from the Danish National Patient Registry. We used logistic regression to analyze the associations between sociodemographic factors and cancer stage. Results: Shorter education, lower income, living without partner, older age and being male were associated with increased odds ratios for advanced stage of melanoma at time of diagnosis even after adjustment for comorbidity and tumor type. Residence in the Zealand, Central and Northern region was also associated with advanced cancer stage. Conclusion: Socioeconomically disadvantaged patients and patients with residence in three of five health care regions were more often diagnosed with advanced melanoma. Initiatives to increase early detection should be directed at disadvantaged groups, and efforts to improve early diagnosis of nodular melanomas during increased awareness of the Elevated, Firm and Growing nodule rule and “when in doubt, cut it out” should be implemented. Further studies should investigate regional differences in delay, effects of number of specialized doctors per inhabitant as well as differences in referral patterns from primary to secondary health care across health care regions.

Abstracts Background: The aim of this cross-sectional study was to investigate the volume, fat mass, and lean mass in both upper and lower limbs measured with dual-energy X-ray absorptiometry (DXA) in melanoma patients with melanoma-related limb lymphedema.METHODS AND RESULTS: Four hundred thirty-one patients who had undergone surgical treatment with wide local excision and unilateral axillary or inguinal sentinel lymph node biopsy and/or complete lymph node dissection participated in a survey, and they underwent clinical examination and measurements of their upper or lower limbs with DXA. Limb lymphedema was diagnosed on the basis of history and characteristic physical findings on the clinical examination. The inter-limb differences in volume, fat mass, and lean mass measured with DXA were categorized as none/mild, moderate, or severe according to reference values (taking handedness into account for the upper limbs). Of the 431 patients, 109 (25%) had clinical melanoma-related limb lymphedema corresponding to 23 (10%) who had undergone axillary nodal surgery and 86 (45%) who had undergone inguinal nodal surgery. The majority of patients developed lymphedema within the first year (90%) after surgery, and the majority of lymphedemas were categorized as mild. The increase in the volume of limbs with lymphedema was primarily due to an increase in fat mass.CONCLUSION: There is a high prevalence of melanoma-related limb lymphedema. The increase in volume in the limb with lymphedema is primarily due to an increase in fat mass. This increase in fat mass in limbs with lymphedema is important for the understanding of the pathophysiology and may be important in the treatment of lymphedema.

INTRODUCTION: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified.METHODS: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014.RESULTS: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8%, and the negative predictive value was 100%.CONCLUSION: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted.FUNDING: This study received funding from the Department of Plastic Surgery, the Research Council at Herlev Gentofte Hospital and the Danish Cancer Society.TRIAL REGISTRATION: The Danish Regional Committee on Biomedical Research Ethics (r. no.: H-4-2014-127), the Danish Data Protection Agency (2012-58-0004, local record no.: HEH-2015-003, I-Suite no.: 03436) and the Danish Melan-oma Group.

Congenital melanocytic naevi (CMN) appear in approximately 2.6% of Caucasians. There is a major demand for treatment but no vital indication. Laser therapy, curettage and excision are available treatment modalities, but there is no ideal treatment with documented long-term effect and without side effects, and the level of evidence for the treatment options is generally low. The risk of malignancy has probably been overestimated, and furthermore new research shows that untreated CMN often show spontaneous lightening. We review the literature for pros and cons of different treatments.

A 65-year-old woman diagnosed with a nodular melanoma on the right shoulder had a PET/CT scan 13 months later demonstrating a FDG-avid mass in the left masseter muscle, which was asymptomatic and not clinically evident. Pathologic analysis confirmed metastasis of melanoma. Further subcutaneous, intramuscular and bone metastases developed and the patient was treated with surgery and immunotherapy. The patient is in complete-remission with no evident metastases seen on PET/CT 2.5 years after treatment with adoptive cell therapy using tumor-infiltrating lymphocytes (TIL therapy). Asymptomatic skeletal muscle metastases identified with PET/CT can have therapeutic and prognostic implications and a PET/CT scan should be performed as a true whole-body scan.

Basal cell carcinoma can be misdiagnosed as acne; thus, carcinoma should be considered in treatment-resistant acne. Although rare, neglected basal cell carcinoma increases the risk of metastasis.

AIM OF DATABASE: The aim of the database is to monitor and improve the treatment and survival of melanoma patients.STUDY POPULATION: All Danish patients with cutaneous melanoma and in situ melanomas must be registered in the Danish Melanoma Database (DMD). In 2014, 2,525 patients with invasive melanoma and 780 with in situ tumors were registered. The coverage is currently 93% compared with the Danish Pathology Register.MAIN VARIABLES: The main variables include demographic, clinical, and pathological characteristics, including Breslow's tumor thickness, ± ulceration, mitoses, and tumor-node-metastasis stage. Information about the date of diagnosis, treatment, type of surgery, including safety margins, results of lymphoscintigraphy in patients for whom this was indicated (tumors > T1a), results of sentinel node biopsy, pathological evaluation hereof, and follow-up information, including recurrence, nature, and treatment hereof is registered. In case of death, the cause and date are included. Currently, all data are entered manually; however, data catchment from the existing registries is planned to be included shortly.DESCRIPTIVE DATA: The DMD is an old research database, but new as a clinical quality register. The coverage is high, and the performance in the five Danish regions is quite similar due to strong adherence to guidelines provided by the Danish Melanoma Group. The list of monitored indicators is constantly expanding, and annual quality reports are issued. Several important scientific studies are based on DMD data.CONCLUSION: DMD holds unique detailed information about tumor characteristics, the surgical treatment, and follow-up of Danish melanoma patients. Registration and monitoring is currently expanding to encompass even more clinical parameters to benefit both patient treatment and research.

Patient-reported outcome measurements (PROMs) are often questionnaires which provide and rate the patient's point of view in the measurement of subjective clinical phenomena such as pain or quality of life. In the second of two articles we describe field-testing, the psychometric theories Classical Test Theory and Item Response Theory, psychometric validation and the measurement properties of a PROM. The latter is based on the COSMIN (consensus-based standards for the selection of health measurement instruments) guidelines, which are developed to assist in development and evaluation of PROMs.

BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP flap in reconstructive surgery.METHODS: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews.RESULTS: A total of 106 TAP flaps were performed in 97 patients. The flaps were raised with either 1 perforator (42/106), 2 perforators (55/106), or three perforators (9/106), and turned as a propeller in 99 of 106 (93%) flaps or buried as a turnover in 7 of 106 (7%) of flaps. The mean operative time was 200 minutes (range, 60-485). Major complications occurred in 10 of 106 (10%) cases and included hematoma (1/108), venous congestion (2/108), and partial flap necrosis (7/108). The reconstructive goal was achieved in 103 of 106 (97%) flaps.CONCLUSIONS: The TAP flap is a pedicled, fasciocutaneous flap that can be used for total breast reconstruction as well as breast conserving surgery. This large, multicenter series describes our techniques of preoperative perforator mapping and a fast, reliable harvest. Reconstructive goals are accomplished in the great majority of patients.

Patient-reported outcome measurements (PROMs) are often questionnaires which provide and rate the patient's point of view in the measurement of subjective clinical phenomena such as pain or quality of life. In the first of two articles we describe five of the six developmental phases of a patient-reported outcome questionnaire. Adherence to good methodology throughout the process is of utmost importance to ensure reliable and valid results from studies using PROM. Patients from the target population should be involved in the process to obtain content and face validation, i.e. through focus groups.

IMPORTANCE: In Denmark, the incidence of malignant melanoma (MM) has doubled during the past 25 years, with an incidence of 29.5 and 31.7 per 100,000 person-years in 2012 for men and women, respectively. Understanding the nature of this increase in incidence is important to optimize prevention, early diagnosis, and treatment of in situ and invasive melanoma in Denmark.OBJECTIVE: To describe changes over time in the incidence and clinical and pathologic characteristics of in situ and invasive melanoma in Denmark from 1985 through 2012.DESIGN, SETTING, AND PARTICIPANTS: We used the official national Danish Melanoma Group database to describe all eligible, prospectively registered cases of in situ and invasive melanoma in Denmark from January 1, 1985, through December 31, 2012. Data analyses were performed from April 1, 2012, through January 31, 2013.MAIN OUTCOMES AND MEASURES: Estimated annual percentage changes (EAPCs) for men and women in European age-standardized incidence, age at diagnosis, and tumor region for in situ melanoma and MM. For MM only, melanoma type, Breslow thickness, ulceration, and mortality.RESULTS: We included 3299 cases of in situ melanoma and 20,760 cases of MM. The incidence (95% CI) of MM increased by 4.5% (3.6%-5.3%) for men and 4.3% (3.5%-5.2%) for women, which was especially pronounced in patients older than 60 years (EAPCs, 5.8% [4.7%-6.8%] and 4.8% [3.8%-5.9%], respectively), in thin (Breslow thickness, <0.75 mm) melanoma (EAPCs, 6.6% [5.0%-8.2%] and 6.1% [6.0%-7.1%], respectively), and in superficially spreading MM (EAPCs, 5.2% [4.3%-6.2%] and 4.7% [3.9%-5.7%], respectively). We found no significant EAPC in the incidence of melanomas with Breslow thickness greater than 2.00 mm in women, and relative ulceration rates (95% CI) declined in both sexes (EAPCs, -3.3% [-4.0% to -2.6%] in men and -3.4% [-4.0% to -2.8%] in women). More proximal tumor location occurred over time (P < .001). Incidence of in sit

INTRODUCTION: The indication for breast reduction in a public welfare or an insurance paid setting depends on the severity of the subjective symptoms and the clinical evaluation. The purpose of this study was to evaluate the use of breast volume as an objective criterion to establish the indication for breast reduction surgery, thus establishing a standard decision basis that can be shared by surgeons and departments to secure patients fair and equal treatment opportunities.MATERIAL AND METHODS: A total of 427 patients who were referred to three Danish public hospitals with breast hypertrophy in the period from January 2007 to March 2011 were included prospectively in the study. The patients' subjective complaints, height, weight and standard breast measurements were registered as well as the decision for or against surgery. Breast volume was measured using transparent plastic cups.RESULTS: Cut-off values for breast volume were calculated based on whether or not the patients were offered reduction surgery. Most patients (93%) with a breast volume below 800 cc were not offered surgery, while most with a volume exceeding 900 cc were offered surgery (94%). In the grey zone between 800 and 900 cc, the indication seemed to be less clear-cut, and additional parameters need to be included.CONCLUSION: Breast volume can be used as an objective criterion in addition to the presently used criteria. Breast volume can easily be measured and has become appreciated by plastic surgeons dealing with patients with breast hypertrophy as a tool which facilitates their decision-making and patients' acceptance of the decisions made.FUNDING: not relevant.TRIAL REGISTRATION: not relevant.

It is possible that reduced function of DNA repair and cell-cycle control genes increases the individual susceptibility to malignant melanoma. As CHEK2 is a cell-cycle master controller, we tested the hypothesis that heterozygosity for the frameshift alteration CHEK2*1100delC is associated with increased risk of malignant melanoma. First, we performed case-control studies of 1,152 Danish and 752 German individuals with malignant melanoma compared with 9,142 Danish and 3,718 German controls. Second, we performed a meta-analysis of CHEK2*1100delC and malignant melanoma, involving 2,619 cases and 17,481 controls. Third, we examined the risk of malignant melanoma associated with CHEK2*1100delC heterozygosity in an analysis stratified for sun exposure, as well as for subtype and location on the body. The odds ratios for malignant melanoma for CHEK2(*)1100del heterozygotes compared with those for noncarriers were 2.01 (95% confidence interval (CI), 1.03-3.91) in Danes, 1.42 (95% CI, 0.46-4.31) in Germans, and 1.79 (95% CI, 1.02-3.17) in Danes and Germans combined. In a meta-analysis, the odds ratio of malignant melanoma for CHEK2*1100delC heterozygotes compared with that for noncarriers was 1.81 (95% CI, 1.07-3.05). Stratifications did not alter these results. CHEK2*1100delC heterozygotes have a twofold risk of malignant melanoma compared with noncarriers.Journal of Investigative Dermatology advance online publication, 29 September 2011; doi:10.1038/jid.2011.303.

We present two cases with signs of infection and granulomas seen years after injection of permanent fillers to the lips. These side effects are difficult to treat. They resemble an immunological foreign body response and late-onset infection as well as granuloma and scaring depending on the substance injected. Steroid injections are indicated in case of granuloma, and antibiotics should be used when infection occurs, but surgical excision can be required. It is important to emphasize this condition in order to give patients proper advice prior to treatment and to recognize symptoms. Udgivelsesdato: 2009-Apr

We investigated if delayed breast implant reconstruction after breast cancer impairs prognosis. Using data from the Danish Breast Cancer Cooperative Group register, we identified all women <70 years who underwent breast reconstruction with implants after mastectomy after invasive breast cancer during 1978 to 1992, on average 2.2 years (range, 3 days-9.4 years) after mastectomy. The reconstructed women were closely matched to breast cancer patients without reconstruction on age and calendar time of diagnosis, tumor size, regional lymph node involvement, and adjuvant radiation therapy. Overall, 580 reconstructed women and 1158 individually matched controls were followed-up for disease-free survival within the first 10 years and for overall survival for an average of 20.1 year (range, 12.8-27.5 years). Disease-free survival was significantly improved hazard ratio 0.78; 95% confidence interval 0.64-0.95 and overall survival was nonsignificantly improved (hazard ratio, 0.90; 95% confidence interval 0.76-1.06) among the breast reconstructed women. This is likely because of differences in socioeconomic and health factors Udgivelsesdato: 2008/7, We investigated if delayed breast implant reconstruction after breast cancer impairs prognosis. Using data from the Danish Breast Cancer Cooperative Group register, we identified all women