This new hernioplasty technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgia with maximum comfort for the patients.

Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

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A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.

This clinical image shows the importance of the early diagnosis and treatment of any suspicious skin lesion. KeywordsBasal cell carcinoma, distant metastasis, radiation therapy, skin lesion.A 58-year-old Caucasian female was referred to our institution for anemia (hemoglobin 52 g/L) due to the bleeding of an exophytic, irregular, thick, ulcerated lesion on the left anterior chest wall. The lesion had been growing for about 10 years and had originated from a preexisting skin lesion. The rest of her past medical history was unremarkable.We performed an incisional biopsy of the lesion. The histological findings were consistent with a metatypical basal cell carcinoma. A chest and abdomen CT scan, performed for the purpose of staging, showed a mass infiltrating the subcutaneous tissues and the intercostal left muscles with a node of 13 9 9 mm placed deeply in the lower third of the left mammary gland. No distant metastasis was observed. The patient started neoadjuvant cytoreductive radiation therapy (50 Gy in 25 fractions), and after 25 days of treatment, we obtained a significant reduction in the lesion size and the extent of bleeding.