The underlying cause of primary lymphedema is a malformation of the lymph vessel system. Secondary lymphedemas can be due to infections, recurrent inflammation, hypoproteinemia, tumors, operations, or irradiation. As a reaction to persistent edema and interstitial macromolecules, fibrosis occurs. Recurrent inflammations of the indurated and edematous tissue are clinically impressive. The massive form of the scrotal lymphedema leads to painful tautness and sexual dysfunction. A concurrent penile edema can cause dysuria. The deformity of the affected extremities and organs not only leads to restriction of mobility but also to psychological stress due to the disfigurement, even as far as to social deprivation. We report on a surgical technique for treating pronounced scrotal edema by resection and neoscrotal reconstruction using ventral pedunculated scrotal skin flaps in cases of congenital hereditary elephantiasis of the Meige type.

Digital papillary adenocarcinoma is a rare tumour originating from sweat glands, often occurring in digits of the hand or foot. We present the case of a 52-year-old mechanic with this tumour at the distal phalanx of the middle finger. It was primarily excised. After histological verification of the diagnosis, amputation and axillary lymphadenectomy was performed. So far, no clinical or histological parameters were found to be predictive for recurrence or metastasis. This indicates that the originally proposed criteria for distinguishing between benign (adenoma) and malignant (adenocarcinoma) do not necessarily predict biologic behaviour. As according to the available literature metastases occurred in 14 % of the described patients within ten years, we propose an aggressive surgical approach consisting of amputation and regional lymph node dissection.