Breast cancer is the most frequent neoplasm among women and the second leading cause of death by cancer. It is the most frequent cancer diagnosed during pregnancy. Pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy and/or in the postpartum period. Data about young women with metastatic HER2-positive cancer who desire a pregnancy are scarce. The medical attitude in these clinical situations is difficult and nonstandardized. We present the case of a 31-year-old premenopausal woman diagnosed in December 2016 with a stage IV Luminal HER2-positive metastatic breast cancer (pT2 N0 M1 hep). The patient was initially treated by surgery in a conservative manner. Postoperatively, the presence of liver metastases was found by CT investigation. Consequently, line I treatment (docetaxel l75 mg/m² iv; trastuzumab 600 mg/5 mL sq) and ovarian drug suppression (Goserelin 3.6 mg sq at 28 days) was administered. After nine cycles of treatment, the patient’s liver metastases had a partial response to the therapy. Despite having a favorable disease evolution and a strong desire to procreate, the patient vehemently refused to continue any oncological treatment. The psychiatric consult highlighted an anxious and depressive reaction for which individual and couple psychotherapy sessions were recommended. After 10 months from the interruption of the oncological treatment, the patient appeared with an evolving pregnancy of 15 weeks. An abdominal ultrasound revealed the presence of multiple liver metastases. Knowing all the possible effects, the patient consciously decided to postpone the proposed second-line treatment. In August 2018, the patient was admitted in the emergency department with malaise, diffuse abdominal pain and hepatic failure. Abdominal ultrasound found a 21-week-old pregnancy which had stopped in evolution, multiple liver metastases and ascites in large quantity. She was transferred to the ICU department where she perished just a few hours later. Conclusions/Discussion: From a psychological standpoint, the patient had an emotional hardship to make the transition from the status of a healthy person to the status of a sick person. Consequently, she entered a process of emotional protection of the positive cognitive distortion type, which favored the decision to abandon treatment and try to complete the pregnancy to the detriment of her own survival. The patient delayed the initiation of oncological treatment in pregnancy until it was too late. The consequence of this delay in treatment led to the death of the mother and fetus. A multidisciplinary team worked to provide this patient with the best medical care and psychological assistance throughout the course of the disease.

Background: Breast cancer mortality and long-term survival are influenced by the unpredictability of recurrences, which cause significant diagnostic and therapeutic challenges for oncology teams. The risk of local and distant recurrence is higher in advanced stages and in the first two years following initial treatment. Accurate staging and continuous monitoring of recurrence are crucial for effective therapy planning. Indicators of recurrence, such as luminal subtype, disease stage, age, and treatment choice, can provide new knowledge and improve patient disease-free and overall survival rates. Methods: We conducted a retrospective cohort study of patients with stage I-III invasive breast cancer at a regional-based institution. The study population consisted of 98 patients with distant and locoregional recurrences from a large cohort of 744 patients diagnosed and treated at our institution between 2007 and 2024. Data on previous treatment for breast cancer, disease stage, molecular subtype, initial size and location of the tumor in the breast, lymph node status, living environment, and type of recurrence were recorded retrospectively. Results: The recurrence patterns in 98 patients included local recurrence in 25 (25.5%), distant recurrence in 70 (71.4%), and both local and distant recurrence in three (3.1%). Our study showed that patients diagnosed with stage II (40.8%) or stage III (55.1%) breast cancer, as well as those with the luminal B subtype (43.87%), were more likely to experience recurrence. The majority of patients affected by recurrent disease were postmenopausal women aged between 51 and 70 years (32 cases aged 51–60 years and 34 cases aged 61–70 years). Tumors measuring between 2 and 5 cm were more likely to produce distant single-organ recurrence (26 cases). More cases were associated with urban areas (77 cases). Conclusions: In menopausal women, most causes of local breast cancer recurrence are related to advanced stage at diagnosis and luminal B subtype. Patient age, primary tumor location in the CSE, and previous adjuvant treatment with aromatase inhibitors may affect the risk of recurrence. Comprehensive studies on recurrence in postmenopausal women can provide a more precise understanding of the extent of disease in such patients.

Acellular dermal matrices (ADMs) are widely used in soft-tissue reconstruction, yet the optimal timing for split-thickness skin grafting (STSG) remains unsettled. We conducted a single-center retrospective cohort study (January 2023–August 2025) of adults undergoing ADM-based reconstruction with Integra^® Double Layer (IDL), Integra^® Single Layer (ISL), or Nevelia^®. Primary endpoints included length of stay (LOS), STSG requirement and timing, and in-hospital complications; secondary endpoints included spontaneous epithelialization. Prespecified adjusted analyses (linear/logistic models) controlled for age, sex, etiology, anatomical site, diabetes/PAOD, smoking, wound size (when available), wound contamination, and matrix type. Histology and immunohistochemistry (H&E, Masson trichrome, CD105, D2-40) assessed matrix integration and vascular/lymphatic maturation. Seventy-five patients were included (IDL n = 40; ISL n = 20; Nevelia n = 15). On multivariable analysis, matrix type was not an independent predictor of LOS (ISL vs. IDL β = +2.84 days, 95% CI −17.34 to +23.02; Nevelia vs. IDL β = −4.49 days, 95% CI −16.24 to +7.26). Complications were infrequent (6/75, 8.0%) and comparable across matrices; spontaneous epithelialization occurred in 3/75 patients (4.0%). A day-14 grafting strategy, applied only after documented clinical integration, was feasible in 30/75 (40.0%) patients without excess complications. Histology/IHC at 3–4 weeks demonstrated CD105-positive, perfused capillary networks with abundant collagen; at 4–6 weeks, D2-40-positive lymphatic structures confirmed progressive neo-dermis maturation, supporting the biological plausibility of earlier grafting once integration criteria are met. In this cohort, outcomes were broadly similar across matrices after adjustment. A criteria-based early STSG approach (~day 14) appears safe and operationally advantageous when integration is confirmed, while a minority of defects may heal without grafting. Prospective multicenter studies with standardized scar/functional measures and cost analyses are needed to refine patient selection and graft timing strategies.

POH (Peri Orbital Hyperpigmentation) represents a minor clinical entity that attracts immense aesthetic damages and it generates social integration difficulties. This review focuses on the etiopathogenic causes of this entity, differentiating and reclassifying this defect as having, on the one hand, genetic causes of melanic hyperproduction – for Fitzpatrick cutaneous phototypes IV and V – and, on the other hand, both genetic and acquired vascular causes, in individuals with light-coloured skin phototypes. Hence, there is a big difference in the field of pathogenic treatment, for the two entities. In addition, this study notes the direct relationship between skin aging and POH, especially for aquired vascular causes. In this reasoning, other aesthetic deficiencies of the skin in the palpebral area should be also considered, like: blepharochalasis, wrinkles, the anatomical causes of the lower eyelid shading, symmetrical or asymmetric suborbital oedema. All of these issues will complicate the therapeutic decision and subsidiary, the pharmaceutical advice. In this context, the review shows the guidelines for a honest councelling of the patients, pointing the efficiency limit for the topical pharmaceutical medication (depigmentants, exfoliants) versus the necessity of minimally invasive or/ and surgical treatments (in blefarochalasis).

Capsular contracture (CC) remains the most common long-term complication of implant-based breast reconstruction (IBBR), significantly impacting cosmetic outcomes, patient satisfaction, and reoperation rates. Despite substantial advances in surgical technique, implant technology, and perioperative management, the incidence of clinically significant contracture persists at approximately 3–5% at five years in non-irradiated patients and escalates dramatically—to 20–50%—in those receiving postmastectomy radiation therapy (PMRT). The etiology is multifactorial, involving subclinical biofilm formation, a dysregulated host immune and foreign-body response, and radiation-induced fibrosis. This narrative review synthesizes contemporary evidence on the pathophysiology, clinical assessment, and modifiable risk factors for CC in IBBR, with particular emphasis on implant surface characteristics (smooth, textured, and polyurethane[PU]-coated), placement plane (prepectoral versus subpectoral), the role of acellular dermal matrices (ADMs), reconstruction timing (direct-to-implant versus two-stage), and the complex interplay with radiotherapy—including radiation timing, fractionation, and emerging delivery techniques. We also address ongoing controversies, including the lack of standardized objective diagnostic criteria, the comparative effectiveness of ADM versus PU-coated implants, and the optimal sequencing of radiation relative to reconstruction. By integrating the latest evidence from very recent major meta-analyses and national registries, this review provides an updated synthesis. We further propose an evidence-based clinical decision framework for CC risk mitigation. This review aims to inform individualized surgical decision-making and identify priority areas for future investigation.

Background and Objectives: This study aimed to identify the risk factors of primary cutaneous melanomas associated with microsatellites, satellites, and in-transit metastases. Materials and Methods: We performed a retrospective study on patients diagnosed with invasive primary cutaneous melanomas in two pathology departments. The cases were distributed into two groups, comparing the clinical–pathological features of cases that presented microsatellites, satellites, and in-transit metastases with cases that did not present microsatellites, satellites, and in-transit metastases. Results: From the total number of primary invasive cutaneous melanomas diagnosed (n = 204), 22% presented microsatellites, satellites, and in-transit metastases (n = 46). The presence of microsatellites, satellites, and in-transit metastases was strongly correlated with a Breslow index > 4 mm, a Clark level of IV or V, and a pT3 or pT4 pathological stage (p < 0.0001). Those cases were also associated with lymphovascular invasion (p = 0.0013), ulceration of the primary melanoma (p = 0.0037), and an increased mitotic rate (p = 0.0078). The presence of microsatellites, satellites, and in-transit metastases is associated with higher rates of lymph node metastases (p = 0.0006) and recurrence (p = 0.0282). Conclusions: The most important risk factors associated with microsatellites, satellites, and in-transit metastases are represented by a Breslow index > 4 mm, a Clark level of IV or V, and an advanced pathological stage.