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Although lipoma is a common benign tumor, it occurs relatively infrequently in the oral and maxillofacial areas, and only 31 cases of lipoma in the buccal fat pad have been reported. Herein, we present an extremely rare case of symmetric lipomas in both buccal fat pads. These masses were incidentally discovered during a facelift procedure in a 50-year-old woman with a 4-year history of tamoxifen use. during which she had gained 10 kg. The patient stated that cheek protrusion had developed concomitantly with weight gain and was exacerbated by an injection lipolysis procedure she had received 1 year previously. This case underscores the importance of paying careful attention to the patient’s medication use and surgical history when evaluating suspected cases of lipoma, and sheds light on tamoxifen use and subcutaneous injections of phosphatidylcholine and deoxycholate as potential risk factors for lipoma development.

Sebaceous carcinoma (SC) is a rare tumor, accounting for approximately 0.7% of skin cancers. SC can be classified as ocular SC (OSC) or extraocular SC (EOSC) depending on its location. Because EOSC accompanied by metastases is rare, there is a paucity of data about EOSC accompanied by metastasis. This study presents a case of an aggressive EOSC of the scalp with lymph node metastases. The patient underwent wide local excision of the primary tumor with a 1 cm safety margin and bilateral radical lymph node dissection. However, recurrence was observed 1 month after surgery. Radiation therapy and resection were performed for the recurrent tumor. However, distant metastases to both lungs eventually occurred. Here, we describe a rare recurrent case of EOSC of the scalp with distant organ metastasis with a review of the literature.

Background In patients with congenital melanocytic nevus (CMN), single-stage removal of large lesions can be difficult because the high tension created by excising and repairing a large lesion may result in scar widening. Herein, we introduce a method to effectively excise lesions while minimizing scarring and compare its outcomes to those of existing surgical methods. Methods We compared patients who underwent surgery using the anchoring technique (n=42) or the conventional elliptical technique (n=36). One side of the lesion was removed via en bloc resection up to the superficial fascia. The other side of the lesion was removed via de-epithelialization. The de-epithelialized dermal flap was then fixed by suturing it to the superficial fascia on the opposite side. The length of the lesion’s long axis and amount of scar widening were measured immediately after surgery and at 2, 6, and 12 months postoperatively. At 12 months, patients were assessed using the Patient and Observer Scar Assessment Scale. Results The lesion locations included the face, arms, legs, back, and abdomen. The anchoring method resulted in shorter and smaller scars than the conventional method. There were no cases of postoperative hematoma or wound dehiscence. Significant differences in postoperative scar widening were found in the arm and leg areas (P Conclusions The anchoring method introduced in this study can provide much better outcomes than the conventional method. The anchoring method is particularly useful for the removal of CMN around the joints or extremities, where the surgical site is subjected to high tension.

Traumatic subcutaneous emphysema, which is the infiltration of air into subcutaneous tissues due to trauma, is caused by various factors such as chest and/or abdominal trauma, facial fractures, and barotrauma caused by mechanical ventilation. In this case report, a 32-year-old woman developed traumatic subcutaneous emphysema after undergoing abdominal liposuction at a local clinic. She was subsequently admitted to Busan Paik Hospital, and with early diagnosis and conservative treatment, she was discharged on the seventh day of hospitalization with no complications. However, because traumatic subcutaneous emphysema may accompany other injuries for various reasons, radiological examination and various tests should be performed to prevent serious complications and sequelae.

Background Epidermal cysts are benign, slow growing cysts that often develop on the head, neck, chest, and back of adults. The most common method of surgical excision involves the use of a scalpel and often leaves a scar proportional to the size of the cyst. Therefore, minimally invasive techniques are required. Among these techniques, the CO2 laser-based technique is minimally invasive and has lower complication rate, shorter recovery times, and lesser scarring. This paper aimed to compare the results and postoperative complications associated with a CO2 laser-based excision against conventional surgical excision for epidermal cysts. Methods We surveyed 120 patients, aged 16 to 65 years, with epidermal cysts on the face measuring 0.5 to 2.2 cm in diameter. Twelve months later, we compared the scar length, recurrence rate, patient satisfaction, and complications between patients treated with CO2 laser excision versus surgical excision. Results The mean scar length (12 months postoperative) after CO2 laser excision was 0.30± 0.15 cm, and that following surgical excision was 1.23± 0.43 cm (p= 0.001). The procedure time (time from incision after local anesthesia to the end of repair) was 16.15± 5.96 minutes for CO2 laser excision versus 22.38± 6.05 minutes for surgical excision (p= 0.001). The recurrence rates in the surgical excision group and CO2 laser excision group were 3.3% and 8.3%, respectively; this difference was not statistically significant (p= 0.648). Conclusion The cosmetic outcome of CO2 laser excision is excellent. For epidermal cysts measuring 2.2 cm or smaller, CO2 laser excision is recommended, especially when aesthetic outcome is considered important.

Recently, dermal fillers have been used with increasing frequency to improve facial contours for cosmetic purposes. The appreciable increase in such filler procedures has led to more adverse events and complications. Herein, we report the clinical significance and differential diagnosis of delayed multiple granulomas that occurred in a patient with a history of an injection of an unknown substance as a filler 20 years previously. She was also taking oral steroids and tacrolimus for immune suppression after a kidney transplant that she received 10 years before she presented with granulomas.

Linear scleroderma en coup de sabre (LScs) is a variant of localized scleroderma. This disease typically occurs in patients in their 20s or younger individuals and predominantly occurs in the forehead area. A 26-year-old man with linear scleroderma was surgically treated at our center with Medpor (porous polyethylene) and dermal fat graft for the forehead lesion. After 26 months of postoperative follow-up, the depressed lesion that appeared scarred as well as the margins improved significantly. The surgical treatment of LScs using Medpor and dermal fat graft is an effective treatment modality that can increase patient satisfaction.

Calcinosis cutis is a condition in which calcium salts are deposited in the skin and subcutaneous tissue due to various causes. These deposits are classified as dystrophic, metastatic, idiopathic, and iatrogenic calcifications [1]. Dystrophic calcification is characterized by damaged or abnormal local tissues without elevated serum calcium and phosphate levels. Metastatic calcification is caused by abnormal calcium and/or phosphate metabolism. Idiopathic calcification occurs even in the absence of tissue damage or metabolic disorders. Moreover, calcification may also occur as a result of tissue damage or impaired mineral metabolism after medical interventions [2]. We experienced a case of an 18-year-old man who had been diagnosed with acute lymphoblastic leukemia (ALL) as a child and developed iatrogenic calcinosis cutis due to the extravasation of intravenous anticancer drugs. Here, we report our case with a review of the literature. In January 2015, a patient initially diagnosed with ALL in June 2001 visited us for the further evaluation and treatment of a mass. Until September 2004, the patient had been treated with methotrexate, vincristine, and cyclophosphamide at the outpatient clinic of the Department of Pediatrics. In 2002, the patient exhibited extravasation of intravenous anticancer drugs on the dorsum of the right hand. At that time, the patient presented with pain, swelling, redness, and tender inflammation. Over two weeks, the redness and inflammation had improved, but the lesion exhibited a gradual tendency towards firmness. A routine laboratory test showed calcium levels of 9.9 mg/dL and inorganic phosphate levels of 5.4 mg/dL. In February 2007, the patient experienced a relapse of ALL. Until August 2010, the patient received secondary chemotherapy using the same drugs. During this period, in 2008, the patient experienced extravasation of intravenous anticancer drugs on the elbow of the right arm. As in 2002, the patient developed a larger mass two weeks later. A routine laboratory test showed calcium levels of 9.5 mg/dL and inorganic phosphate levels of 5.3 mg/dL. Both masses persisted without changes in their size (Fig. 1). Fig. 1 Preoperative view of the patient. (A) The mass on the dorsum of the right hand. (B) The mass on the elbow of the right arm. On radiography, the patient had a radiopaque lesion at the site of each mass. On sonography, the patient had calcified lesions in the subcutaneous fat layer; the lesion on the dorsum of the right hand measured 3.0×1.1×0.5 cm, and the lesion on the elbow of the right arm measured 4.0×2.6×1.3 cm. These findings were interpreted as a heterotopic ossification. On January 21, 2015, the patient underwent resection of the mass under general anesthesia. Intraoperatively, two subcutaneous encapsulated masses were found: one was found on the dorsum of the right hand and measured 2.4×1.5×0.5 cm, and the other was found on the elbow of the right arm and measured 5.2×2.8×1.4 cm (Fig. 2). Postoperatively, the patient underwent tissue biopsy and was diagnosed with calcinosis cutis (Fig. 3). Thereafter, the patient underwent follow-up at our outpatient clinic, but showed no episodes of recurrence. Fig. 2 Intraoperative view of the patient. (A) The mass on the dorsum of the right hand. (B) The mass on the elbow of the right arm. Fig. 3 Pathologic image showing calcium salts, which can be recognized as either fine granules or small deposits in the dermis (H&E, ×100). Calcinosis cutis may be misdiagnosed as cellulitis, osteomyelitis, arthritis, abscess, periostitis, myositis ossificans, and thrombophlebitis. It is frequently encountered in a clinical setting. When a preoperative X-ray or sonography shows heterotopic ossification, differential diagnoses should include osteoma cutis and calcinosis cutis. Osteoma cutis is a condition in which bone tissue is formed on the skin, with the emergence of a focus of calcification arising from the inflammatory scar or from a granuloma of bony tissue. In contrast, calcinosis cutis is characterized by the deposition of calcium salt in the skin and soft tissue, with the involvement of bony tissue. The pathogenesis of calcinosis cutis has not been fully elucidated. However, many factors causing this disease have been established, and different clinical scenarios, involving various forms of calcinosis cutis, arise from different causes. Tumoral calcinosis is characterized by calcium deposition around joints, and appears in healthy adolescents. It is a type of metastatic calcification that accompanies hyperphosphatemia, and develops after swelling without pain at the major joints such as the shoulder, hips, and elbows. Leukemia cutis occurs with paraneoplastic hypercalcemia due to bony metastases or the production of an abnormal hormone that directly affects calcium and bone metabolism. According to Lestringant et al. [3], this disease is widespread and mainly affects the blood vessels, kidneys, lungs, and gastric mucosa, as well as the skin or subcutaneous tissue. Furthermore, diffuse osteoporosis or spontaneous fractures of small bones may appear. In our case, it was possible to distinguish the clinical course of tumoral calcinosis from leukemia cutis. When the mass first developed, the patient's serum calcium levels were within the normal range and phosphate was slightly elevated, but within the normal range considering that the patient was a child at the time. Therefore, we were able to exclude metastatic calcification with hyperphosphatemia and hypercalcemia. Unlike the general pattern of occurrence observed in diffuse leukemia cutis, the mass arose at the venipuncture site after intravenous injections, subsequent to pain, swelling, and redness. Some case reports have described iatrogenic calcinosis cutis as a complication of the intravenous use of calcium chloride or calcium gluconate [4]. These authors have also noted that iatrogenic calcinosis cutis occurs between two hours and 24 days after extravasation, with an average delay of 13 days [5]. The case of our patient corresponded to this pattern, with calcinosis cutis caused by the extravasation of calcium solutions. The patient developed a mass two weeks after the extravasation of anticancer drugs, which is consistent with the clinical manifestation of calcinosis cutis arising from the extravasation of calcium chloride. According to Goldminz et al. [5], the pathophysiology of calcinosis cutis is based on tissue damage arising from the extravasation of a solution followed by the deposition of crystalline or insoluble calcium phosphate minerals. However, we did not use intravenous calcium therapy. We assume that this case was solely caused by the extravasation of anticancer drugs. The tissue damage caused by the extravasation of anticancer drugs may be assumed to have played an important role in the onset of calcinosis cutis. This is the first case report of calcinosis cutis caused by the extravasation of intravenous anticancer drugs. We believe that our rare case may help elucidate the pathogenesis of calcinosis cutis.

There are 2 predominant mechanisms that are used to explain the pathogenesis of orbital blowout fracture; these include hydraulic and buckling mechanisms. Still, however, its pathophysiology remains uncertain. To date, studies in this series have been conducted using dry skulls, cadavers, or animals. But few clinical studies have been conducted to examine whether the hydraulic mechanism is involved in the occurrence of pure orbital blowout fracture. The authors experienced a case of a 52-year-old man who had a pure medial blowout fracture after sustaining an eye injury because of a high-pressure air gun. Our case suggests that surgeons should be aware of the possibility that the hydraulic mechanism might be involved in the blowout fracture in patients presenting with complications, such as limitation of eye movement, diplopia, and enophthalmos.