Giant congenital melanocytic nevi are rare, and it is recommended to excise due to the possibility of malignancy. Although tissue expansion for nevus removal involves multiple stages, the advantages of tissue expansion are known well. We report a case of a giant congenital melanocytic nevus of the upper extremity that extended from the elbow to the shoulder. This case was challenging due to the circumferential nature of the lesion, the lack of healthy skin, the need to ensure minimal scarring, and the desire to impact the patient’s daily life as little as possible. The use of a pre-expanded thoracodorsal artery perforator (TDAP) flap and re-expansion of the transferred flap were considered most appropriate. A pre-expanded pedicled TDAP flap can be transferred to any anatomical region with its versatility. The re-expansion of the transferred flap ensures the health of the skin and minimizes donor site scarring. Here, we achieved the optimal outcome through the combined use of a pre-expanded pedicled TDAP flap and sequential re-expansion of the transferred flap in the treatment of a giant nevus of the upper extremity.

Background: Autologous fat is considered an ideal filler material, and the use of cryopreserved fat grafts is promising in terms of flexibility and efficiency. Therefore, cryopreserved fat grafts have become more common in recent years; however, their complications require further consideration. Methods: We evaluated 53 patients who underwent facial lipofilling at our institution to confirm the clinical usefulness and safety of cryopreserved fat. Fresh fat injections with or without cryopreserved fat were administered. At one or more sites, 22 patients had a single fresh fat injection, four patients had two or more fresh fat injections, 16 patients had one fresh fat injection followed by one cryopreserved fat injection, six patients had one fresh fat injection followed by two cryopreserved fat injections, and five patients had two fresh fat injections and one or more cryopreserved fat injections. Results: In total, 281 sets of injection procedures were performed at various sites, of which 170 involved one fresh fat injection, 89 involved one fresh fat injection and one cryopreserved fat injection, and 11 involved one fresh fat injection and two cryopreserved fat injections. One patient experienced self-resolving inflammation as a complication after the second injection in the right cheek. No statistically significant differences were found between the fresh and cryopreserved fat injections. Conclusion We suggest that cryopreserved fat is a useful and safe resource for multiple fat injections, with advantages including aseptic fat handling and the delicacy of the technique.

Renal cell carcinoma (RCC) represents 2% to 3% of human cancers and is aggressive, with metastatic capability. The frequent metastatic sites are lung, bone, and liver. Reports of RCC metastatic to skin, and especially scalp are rare. Here we present an 83-year-old woman who was diagnosed with RCC 19 years prior and had a metastatic scalp lesion. An 83-year-old woman presented with a red-to-purple, protruding lesion at the right parietotemporal area. Twenty-three years ago, a right renal mass was incidentally discovered on ultrasound through a routine medical examination. She underwent right nephrectomy for RCC 4 years later. Five months after nephrectomy, new lung nodules were observed. Fifteen years after nephrectomy, metastatic lesions were found in the pelvic bone. She visited dermatology department for evaluation of the new scalp lesion, a year before she first visited our department. Despite chemotherapy, the mass was gradually enlarged. She consulted the plastic surgery department for management of the metastatic RCC was successfully treated with total excision including a 1-cm safety margin, local flap, and STSG coverage. Complete healing was observed, without evidence of recurrence during a 7-month follow-up. Metastases to the skin are rare, but must be kept in mind because of its high metastatic ability and poor prognosis.
Aged, 80 and over ; Carcinoma, Renal Cell ; Dermatology ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Pelvic Bones ; Prognosis ; Recurrence ; Scalp ; Skin ; Skin Neoplasms ; Surgery, Plastic ; Ultrasonography