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Lawrence Chukwudi Nwabudike,1 Ana Maria Oproiu,2,3 Ioana Mihaela Dogaru,2,3,* Mariana Costache,3,4,* Alin Laurentiu Tatu5– 7 1Outpatient Dermatology, N. Paulescu National Institute of Bucharest, Bucharest, Romania; 2Department of Plastic Surgery, Emergency University Hospital, Bucharest, Romania; 3Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 4Department of Pathology, Emergency University Hospital, Bucharest, Romania; 5Clinical Medicine Department, Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, Galati, Romania; 6Dermatology Department, St Parascheva Clinical Hospital of Infectious Diseases, Galati, Romania; 7Multidisciplinary Integrated Center for Dermatologic Interface Research (MIC-DIR), Galati, Romania*These authors contributed equally to this workCorrespondence: Lawrence Chukwudi Nwabudike, N. Paulescu Institute of Bucharest, 5-7 Ion Movila Street, Sector 2, Bucharest, Romania, Email Chukwudi.nwabudike@live.com Ana Maria Oproiu, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Email anamariaoproiu@gmail.comAbstract: Spontaneous regression of malignant melanoma was first reported over a century ago. Clinically, areas of blue or grey colouration in lesions may be indicative of regression. Dermoscopy is a very useful tool for diagnosing regression. An important criterion is the blue-white scar. About 10– 35% of excised melanomas show features of regression histopathologically. We present a case of regressing melanoma, with clinical and dermoscopic features suggesting a collision tumour, diagnosed histopathologically. This case might improve our knowledge of the potential clinical manifestations, and the biology, of regressing melanoma.Keywords: regressing melanoma, collision lesion, blue-white scar, pepper-like granules, milia-like cysts, pseudofollicular openings

Lawrence Chukwudi Nwabudike,1,* Ana Maria Oproiu,2,3,* Ioana Mihaela Dogaru,2,3,* Mariana Costache,2,4,* Cristian Onisor,5 Alin Laurentiu Tatu5– 7 1N. Paulescu National Institute of Diabetes, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Plastic Surgery, Emergency University Hospital, Bucharest, Romania; 4Department of Pathology, Emergency University Hospital, Bucharest, Romania; 5Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, Galati, 800008, Romania; 6Dermatology Department, ’Sf. Cuvioasa Parascheva’ Clinical Hospital of Infectious Diseases, Galati, Romania; 7Multidisciplinary Integrative Center for Dermatologic Interface Research MIC-DIR, Galati, Romania*These authors contributed equally to this workCorrespondence: Lawrence Chukwudi NwabudikeN. Paulescu National Institute of Diabetes, 5-7 Ion Movila Street, Sector 2, Bucharest, RomaniaEmail Chukwudi.nwabudike@live.comCristian OnisorDunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, 47 Domneasca Str., Galati, 800008, RomaniaEmail cristi.onisor@gmail.comAbstract: Malignant melanoma is a deadly form of skin cancer, and prompt diagnosis is a key factor in providing adequate, life-saving therapy. A 75-year-old man, with long-standing type 2 diabetes mellitus, presented with a 2- to 3-year history of right heel ulcer. He had received various therapies for a diagnosis of diabetic foot ulcer, to no avail. Physical examination showed a black, fungating ulcerated lesion on his right heel, with minimal bleeding. No inguinal lymphadenopathy was palpated. A biopsy was done, which revealed BRAF-negative malignant melanoma, with a vertical growth phase, Breslow 3.1 mm, ulceration, 11 mitoses/mm2, Clark level IV, no lymphatic or vascular invasion observed. Right inguinal lymph node sampling suggested no involvement, but PET-CT suggested pulmonary, right inguinal lymph node and bone involvement. The patient was referred to the oncologists. Written informed consent for publication was given by the patient. Diabetic foot ulcers are a frequently encountered, but serious complication of diabetes mellitus. Delayed healing is often seen, despite adequate therapy. The differential diagnosis of diabetic foot ulcers is vast and includes neoplasia. When a foot ulcer fails to heal, other differential diagnoses must be considered, in order for the patient to receive adequate therapy. Here specialist consultations, including dermatology consultations, could improve chances of delivering the right therapy promptly. This is a factor underlying the emphasis on a multidisciplinary approach to foot ulcer therapy. Our presentation – reported according to the CARE guidelines – also illustrates the fact that failure to reach a timely diagnosis may deny the patient the opportunity to receive adequate treatment. In such cases, “delayed therapy becomes denied (or failed) therapy”, paraphrasing the old adage “Justice delayed is justice denied”.Keywords: malignant ulcer, case report, acral malignant melanoma, diabetic foot ulcer, type 2 diabetes mellitus, delayed therapy

(1) Importance of problem: Breast cancer accounted for 685,000 deaths globally in 2020, and half of all cases occur in women with no specific risk factor besides gender and age group. During the last four decades, we have seen a 40% reduction in age-standardized breast cancer mortality and have also witnessed a reduction in the medium age at diagnosis, which in turn means that the number of mastectomies performed for younger women increased, raising the need for adequate breast reconstructive surgery. Advances in oncological treatment have made it possible to limit the extent of what represents radical surgery for breast cancer, yet in the past decade, we have seen a marked trend toward mastectomies in breast-conserving surgery-eligible patients. Prophylactic mastectomies have also registered an upward trend. This trend together with new uses for breast reconstruction like chest feminization in transgender patients has increased the need for breast reconstruction surgery. (2) Purpose: The purpose of this study is to analyze the types of reconstructive procedures, their indications, their limitations, their functional results, and their safety profiles when used during the integrated treatment plan of the oncologic patient. (3) Methods: We conducted an extensive literature review of the main reconstructive techniques, especially the autologous procedures; summarized the findings; and presented a few cases from our own experience for exemplification of the usage of breast reconstruction in oncologic patients. (4) Conclusions: Breast reconstruction has become a necessary step in the treatment of most breast cancers, and many reconstructive techniques are now routinely practiced. Microsurgical techniques are considered the "gold standard", but they are not accessible to all services, from a technical or financial point of view, so pediculated flaps remain the safe and reliable option, along with alloplastic procedures, to improve the quality of life of these patients.

Introduction: Adjuvant radiotherapy poses the most serious challenges for surgeons who must choose both the time and the optimal reconstructive method for radiotherapy patients. One of the postmastectomy reconstructive techniques, in patients subjected to radiotherapy, is the method that combines the own tissue with the alloplastic material, the latissimus dorsi flap and the breast implant. This method is highly versatile and can be safely applied to radiotherapy patients. Materials and Methods: Between April 2014 and April 2020, we performed 219 breast reconstructions of which 156 cases were reconstructed with latissimus dorsi flap and implant. The main elements studied were: patient selection for the above mentioned technical procedure, indication of operative moment and type of intervention, preoperative measurements and sketching, minimal scar of the donor area, decision to perform simultaneous symmetrization, simultaneous prophylactic mastectomy with immediate reconstruction, cosmetic appearance, stability and evolution of results over time. The follow-up period was 1 year for all patients, while in the case of some patients up to 5 years. Results: This technique could be applied in all cases with radiotherapy, regardless of the size of the contralateral breast, the technique allowing the shaping of breasts of different volumes. The cosmetic appearance has improved over time, the breast having characteristics similar to the healthy one - shape, natural ptosis, consistency, well-defined inframammary groove. Simultaneous symmetrization by breast reduction, mastopexy with or without implant or breast augmentation led to superior results and a high degree of patient satisfaction. The average duration of recovery was 4 weeks, with rapid social and professional reintegration of patients. The small number of complications - 1 total flap necrosis, 3 cases of partial necrosis, 5 seromas, with a small number of reinterventions - 4, make this method one of the safest in the difficult context of the radiotherapy treatment of prepectoral area. Conclusions: Careful planning of breast reconstruction with the help of the latissimus dorsi flap in combination with the breast implant, the meticulous technique determines stable results over time, with superior cosmetic appearance of the breasts reconstructed with the aid of this method, while minimizing the risk of complications. Thus, the quality of life of patients is much improved, and the social and professional reintegration is relatively fast., (Celsius.)

Skin cancer is a common healthcare issue that affects millions of people worldwide. Only a small part of that population is suffering from melanoma and an even smaller proportion has melanoma developed on a pre-existing nevus. This paper illustrates five such cases, diagnosed over an 18-month period, with their histological particular aspects. Among the total number of patients diagnosed and treated in the Department of Plastic and Reconstructive Surgery, University Emergency Hospital, Bucharest, Romania, over approximately one year, of which half for melanoma in general or for benign nevi, only a small fraction had developed melanoma on a common or dysplastic nevus. These patients, as well as those with de novo developed melanoma, are a reason for concern since most of the lesions were diagnosed in a locally advanced stage of the disease. Though efforts are being made to screen and diagnose early, there are still a lot to be done in order to lower the mortality and morbidity rates for this pathology.