Introduction: Pilomatricoma, also known as benign calcifying epithelioma of Malherbe, is a follicular tumor originating from cells in the hair follicle matrix. It usually manifests as a firm subcutaneous mass up to 3 cm in size. Less commonly, it may measure >5 cm and in such cases is called giant pilomatricoma. We herein present a case of a subcutaneous lesion that was characterized by aggressive biological behavior and initially thought to be malignant but subsequently found to be a rare angiomyxoid variant of giant pilomatricoma. Case presentation: This case involved a young, healthy woman with a rapidly growing subcutaneous lesion on the distal lateral side of her right arm. An incisional biopsy was performed, and the lesion was diagnosed as hyperplasia of the epidermis and subcutaneous tissue, likely of reactive nature. After radical excision, analysis of the entire specimen led the pathologist to diagnose a rare variant of giant pilomatricoma with angiomyxoid stroma. Discussion: Classic pilomatricoma is an indolent, slow-growing lesion that is well defined and not fixed to the underlying tissue planes. However, after showing no signs of enlargement for 6 months, the lesion in the present case began to grow in a very unusual and concerning manner, suggesting a skin malignancy. The patient’s young age and the rapid development and large dimensions of the lesion led us to suspect a sarcoma. Conclusion: This case highlights the importance of cooperation between the dermatosurgeon and the pathologist to ensure thorough evaluation of such misleading cases. Such cooperation will guide appropriate management decisions and avoid overtreatment of benign lesions.

Background and Clinical Significance: Hidradenitis suppurativa (HS) is a chronic, debilitating skin disorder that often affects the inframammary fold (IMF). While surgical management, particularly wide local excision (WLE), is the gold standard for severe cases, less is known about the role of breast surgery techniques in treating HS in this area; Case Presentation: This report presents two cases of female patients with bilateral inframammary HS and mammary hypertrophy, both treated with reduction mammaplasty to excise diseased tissue while addressing breast volume and contour. Both patients had experienced inadequate response to medical therapies, including biologic treatments, and presented with distinct clinical features—one with significant asymmetry and active disease, and the other with more scarring and hypertrophic lesions. During follow-up, no recurrence of disease was observed and both patients reported improved breast appearance and satisfaction; Conclusions: These cases underscore the importance of a multidisciplinary approach, with dermatologists and surgeons both playing a key role in the management of this complex condition.

Complex metacarpal fractures with segmental bone loss and joint involvement pose significant challenges for the hand trauma surgeon. When traditional techniques are inadequate, microsurgical reconstruction and joint arthroplasty may offer a viable alternative. We report the case of a 32-year-old male who sustained a high-energy injury to the right hand, resulting in a comminuted fracture of the second metacarpal head and extensive dorsal soft tissue loss. After initial management, reconstruction of the second metacarpal was performed using a free osteocutaneous fibula flap. Although the vascularized bone graft was sculpted to settle in the metacarpophalangeal joint, mobility was not preserved. A staged silicone MCP arthroplasty then was later performed to improve joint mobility. At 18 months follow-up, the patient showed good soft tissue coverage, restored grip strength and proximal interphalangeal joint motion, but improvement in MCP range of motion remained partial despite arthroplasty. This article highlights the potential and limitations of combining vascularized bone transfer with prosthetic joint replacement in high-demand patients following trauma.