Preputial melanoma.

Background: Melanomas of the glans penis, prepuce, and the corpus of the penis account for less than 1% of all melanoma cases. Due to this rarity, there is currently no standard treatment approach.

Case Description: We present the case of a 59-year-old patient with tumorous formations in the prepuce area.

Tumorous formation of the forehead.

T‑cell non-Hodgkin's lymphoma (NHL) represents approximately 10% to 15% of all lymphomas in Western countries. We present the case of a 16-year-old girl with nodular erosive tumor formation on the forehead within the previous 3-4 months and clinical evidence of cervical and submandibular lymphadenopathy in parallel. Tuberculosis verrucosa cutis, lupus vulgaris, cutaneous leishmaniasis, pyoderma faciale, sporotrichosis, infected insect bite, B‑cell lymphoma, and atypical acneiform eruption were considered in the differential diagnosis.

Granulomatous slack skin mycosis fungoides developing simultaneously with sarcoid-like lesions in a patient with repeated anabolic injections in the past?

We present a 32-year-old man with successful treatment and remission of mycosis fungoides of both axillae in 2016 after PUVA therapy and systemic and local administration of corticosteroids. Subsequently, in 2017, the patient also achieved remission of a T-cell CD 30 positive, ALK-1 negative large-cell lymphoma of a retroperitoneal and inguinal lymph node after chemotherapy and radiotherapy. One year later, in 2018, the patient presented to our clinic with progression of skin lesions in both axillary areas and the appearance of а tumor in the right gluteal region.

Acanthosis Nigricans - A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies!

Background: Acanthosis nigricans (AN) is acquired hyperpigmentation of the intertriginous body regions. Histologically, AN is characterised by a thickened stratum corneum and a variable amount of acanthosis. Although benign and rarely symptomatic, AN may be a red flag for underlying pathologies.

A Painful Step - Pendulating Plantar Eccrine Poroma.

Background: Eccrine poroma is a benign tumour of eccrine duct epithelium. The usual clinical presentation is nodular.

Case Report: We present a 78-year-old man with a painful pendulating flesh-coloured malodorous plantar tumour.

Dermal Pleomorphic Sarcoma of the Scalp - Report of Two Cases.

Background: Neoplasias of the UV-exposed head-and-neck area of the elderly include non-melanoma skin cancers of various origin.

Case Report: We report two cases of rapid growing exophytic scalp tumors on chronic sun-damaged skin, in one case with a tendency of bleeding. The tumours were removed by wide surgical excision with 3D margin control, and the resulting defect was covered by a meshed split skin graft.

Eosinophilic Fasciitis - Report of Three Cases and Review of the Literature.

Background: Eosinophilic fasciitis is a rare fibrosing disorder of muscle fascia with rapid onset of erythema, induration, oedema and tenderness affecting extremities bilaterally.

Case Report: We report three cases of eosinophilic fasciitis in 3 females aged 64, 65 and 73 years, in two of them in association with morphea. They fulfilled the proposed diagnostic criteria.

High-Risk Basal Cell Carcinomas of the Head and Neck: Selected Successful Surgical Approach in Three Bulgarian Patients!

Background: Regarding localisation, basal cell carcinomas are classified in three risk groups, designated as H for high-, M as medium-, and L as low-risk area. In patients with high-risk basal cell carcinomas (BCCs), as a first-line of treatment are mentioned, different types of surgical approaches and radiotherapy. Depending on the location of the tumour, the choice of surgical technique should vary and be consistent with the patient's will for a most aesthetically acceptable result.

Multiple Epidermal Cysts of the Scalp: Dermatosurgical Approach with Favourable Outcome!

Background: Epidermal cysts are subcutaneous tissue formations that are most commonly located in the area of scalp, trunk and face. In addition to single ones, the cysts may also be multiple, located near each other. Although they are considered to be a cystic ectasia of the hair infundibulum and mainly affect hairy parts, they can also be seen in the area of palms and feet as a result of trauma.

Giant Pelvic Neurofibroma in Patient with Plexiform Sciatic Neurofibroma and Neurofibromatosis Type 1.

Background: Neurofibromatosis is a genetic disease with an autosomal dominant type of inheritance. It is a multisystem disease in which, besides skin manifestations, there is a possibility for the involvement of other organs and systems, and an atypical variant of neurofibromatosis type 1 can also be observed- the so-called plexiform neurofibroma. In patients with this inherited disease, mortality is higher due to the existing risk for malignant transformation and development of malignant peripheral nerve sheath tumours (MPNSTs) or neurofibrosarcoma.

Primary Regressive, But Metastasizing Melanoma!?

Background: Cases of regressive melanomas represent a diagnostic and therapeutic challenge because time intervals between the presence of the primary tumour formation, the metastasis and the involution of the primary tumour may intertwine or occur at different times. The regression of cutaneous melanomas does not necessarily guarantee prevention from the development of locoregional or distant metastases. There are cases in which the prognosis of patients with the development of subsequent metastasis within regressive melanomas may be better depending on the number and location of metastases.

Scleromyxedema (Arndt - Gottron Syndrome) Developing Under Tenofovir Treatment for Hepatitis B: Unique Presentation in a Bulgarian Patient!

Background: Scleromyxedema, also referred to as the Arndt-Gottron (S-AG) syndrome or the systemic form of Lichen myxedematosus (LM), is a cutaneous mucinosis with a chronic course and high lethality from systemic involvement of other organs and systems. Interesting in several aspects is the association between scleromyxedema and viral hepatitis about: 1) hepatitis virus infection as a possible etiological factor for the development of scleromyxedema, 2) antiretroviral therapy for the treatment of hepatitis as a method of reversing scleromyxedema and 3) antiviral drugs as inducers of scleromyxedema.

Case Report: We present a 53-year old patient who for nine months had been on tenofovir disoproxil 245 mg (0-0-1) therapy for chronic hepatitis B.

Cutaneous Tumour of the Left Cricothyroid Area!?

Background: The cricothyroid area is an atypical localisation for placement of basal cell carcinomas. The main differential diagnosis for cutaneous tumours in this area is between BCC, spinocellular carcinoma and melanoma. The area is problematic about the choice of therapeutic approach, especially in the case of a vague clinical tumour type accompanied by enlarged lymph nodes in the immediate proximity.

The One Step Melanoma Surgery (OSMS): A New Chance for More Adequate Surgical Treatment of Melanoma Patients!?

One step melanoma surgery (OSMS) is applicable to all patients with clear clinical and dermatoscopic criteria for thin cutaneous melanomas or melanoma in situ lesions, even without the need for preoperative tumour thickness measurement. Amelanotic melanomas and melanomas with clinical and dermatoscopical features for regression zones could be problematic when applying the OSMS. The methodology could be also applicable to all groups of patients where the tumour thickness could be measured preoperatively/by ultrasound (while in parallel also determining the status of the locoregional lymph nodes).

Hidradenitis Suppurativa (Hurley I/II): Serial Excisions with Primary Wound Closure Under Local Anesthesia As Most Adequate Treatment Approach.

Background: Acne inversa as a chronic inflammatory disorder can be divided into three stages according to Hurley's classification. It affects the axillary and anogenital region predominantly, and its chronic course of development is associated with a major negative impact on quality of life, especially in young patients. We discuss the different types of treatment in patients with acne inversa and the benefits of two-stage surgical treatment by serial excisions with primary wound closure under local anaesthesia.

Irbesartan Induced Cutaneous Melanoma! Second Case in the Medical Literature!

Background: Drug-induced melanoma is a topic, concept or "reality" becoming more and more popular as the list of drugs considered as potential inducers of cutaneous melanoma is constantly growing. Interesting and current at the moment is the question/dilemma of "Irbesartan induced melanomas" and "Valsartan induced melanomas"! The following questions are without answers: 1) the general risk which angiotensin receptor blockers contain for potentiating the carcinogenesis and cancer development (as a whole); 2) available officialized data for withdrawal from the market of products with valsartan and irbesartan due to detected potential carcinogens-NDMA/NDEA, and 3) the missing official information on the most likely forms of cancer potentiated by these drugs. That is precisely why many questions remain open, and the inevitable assumption arises for the key, although according to some conspiratorial role of so-called "pharmaceutical giants" in the concept of drug-induced malignancies.

Drug-Induced Melanoma: Irbesartan Induced Cutaneous Melanoma! First Description in the World Literature!

Background: Melanoma appears to be a malignant disease, whose development can be potentiated by different drug groups. More and more data are in favour of the claim that commonly used antihypertensive drugs also contain the risk of developing melanoma. The most evidence is that angiotensin receptor blockers may be carcinogenic.

Valsartan Induced Melanoma?! First Description in Medical Literature!

Background: Drug-induced carcinogenesis is a matter of huge popularity and the subject of in-depth research over the last few years. According to the literature, dopamine agonists and acetylsalicylic acid fall into the list of drugs likely to potentiate the development of cutaneous melanoma. However, according to recent data, widely used angiotensin receptor blockers (ARBs) for the treatment of arterial hypertension, also carry a risk of malignancy development.

Lymphangiosis Carcinomatosa in a Patient with Giant Cutaneous SCC: Cervicopectoral Advancement Flap in Combination with Tunnel Transposition Flap from the Back as Promising Treatment Approach?

Background: One of the features characterising cutaneous SCC as high-risk is lymphovascular infiltration. The diffuse lymphangitic spread of carcinogenic cells is defined as the so-called lymphangitis carcinomatosa. In some cases, it is the only and first sign to alert the presence of an underlying malignancy.

Comparative Analysis of the "Scholastic" Recommendations of the AJCC From 2011 for the Surgical Treatment of Cutaneous Melanoma with the Newly Suggested Guidelines for OSMS From the Bulgarian Society For Dermatologic Surgery!

Background: The American Joint Committee on Cancer (AJCC) offers a two-stage, often insufficient or so-called variable model of cutaneous melanoma treatment. This model starts with primary excision and an initial operational safety margin of 0.5 cm in all directions, followed by a re-excision with an additional field of operational security, determined by histologically established tumor thickness (with or without removal of SLN).

Multiple Primary Cutaneous Melanomas in a Bulgarian Patient: The Possible Role of One Step Melanoma Surgery (OSMS) As the Most Adequate Treatment Approach!

Background: Simultaneous occurrence of multiple primary melanomas is a rare, however possible phenomenon, and it is believed that older, male, white, Atypical Mole Syndrome carriers (sporadic and familial) are part of the possible risk factors for its occurrence. In these patients, it is possible to observe involutional changes or (partial/complete) regression of melanocytic lesions, which are likely to be caused by the generation of a spontaneous immune reaction against specific tumour antigens.

Case Report: A 58-year-old male patient is presented with two melanocytic lesions located in the right clavicle (subclavicular area) and left the scapular area that meets clinically and dermatoscopically the requirements for malignant melanoma.

High-Risk BCC Of the Lower Eyelid in Patient with Presternal Located Cutaneous Melanoma and BCC Of the Shoulder: Melolabial Advancement Flap Combined with Undermining Surgical Approach As Promising Complex One Step Treatment Option!

Background: It is assumed that the occurrence of keratinocyte and melanocytic tumours is multifactorial driven. Certain risk factors such as solar radiation, p53 protein and Melanocortin-1 receptor (MC1R) prove to be common to their development, which at the same time shows that their simultaneous manifestation in the same patients, for example, is quite possible. Such a manifestation could be observed as collision tumours within the same solitary lesion or as a simultaneous occurrence within two completely different lesions that are clearly distinguished from one another.

Lipoma of the Neck.

Background: Lipomas are benign formations with the mesenchymal origin, which are found in the head and neck region in a very small percentage of cases. In these cases, they usually occur in the posterior neck and usually grow very slowly without causing complaints. However, when they cover the front of the neck, it is necessary to confirm the adipose origin of a tumour and to exclude the connection with the thyroid gland.