Introduction: Atypical fibroxanthoma is a low grade soft tissue sarcoma infiltrating the dermis containing pleomorphic spindle cells. Pleomorphic dermal sarcoma is a rare dermal tumour on the same morphological spectrum as atypical fibroxanthoma, with greater potential for malignancy. Distinguishing between the two tumours can have a significant impact on management. Case: An 81-year-old gentleman presents with a black haemorrhagic lesion demonstrating features of atypical fibroxanthoma. The diagnostic pathway of this case is followed, focusing on wide local excision and histopathological examination of the offensive tissue, and highlighting decisions made during these stages. Discussion: Common clinical features of atypical fibroxanthoma is detailed, and potential for larger trials to focus on clinical features in symptomatic individuals. The difficulty orientating auricular tissue and methods to reduce potential loss of tissue is discussed. Finally, this report delves into guidelines for wide local excision and what is appropriate for atypical fibroxanthoma or pleomorphic dermal sarcomas. Conclusion: Management of atypical fibroxanthoma can vary from pleomorphic dermal sarcoma or more aggressive sarcomas. This report emphasises the need for a streamlined diagnostic pathway to improve treatment benefit for patients and reduce waiting times.

Objective This study was conducted to find out if the SSD Rhinoplasty induce less pain early post operatively which will plays an important role patients satisfaction and to evaluate the numbness after this relatively new procedure and numbness in an important and common side effect of the conventional Rhinoplasty. Methods One Rhinoplasty consultant has operated on 30 cases using SSD technique after informed and detailed consent, then the virtual pain score was recorded on the 7th day. And the numbness was evaluated 6 months after surgery. Results Patients in this series (18 men, 12 women) ranged in age from 23 to 54 years (mean, 24.3 years). 24 were primary Rhinoplasty, and 6 were revision Rhinoplasty; Pain scores: The study revealed that the median: 2.0 mean pain score median: 2.0. Numbness over the nose and nasal tip: 20 (83%) patients with primary Rhinoplasty had no numbness, but 4 (17%) patients had early numbness that improved after six months. However, all revision cases (6 patients) had short and long-term numbness after 6 months. Conclusions. SSD Rhinoplasty shortens the dissection time and makes it faster to raise the envelope even with revision cases. Also, it procured much less pain among all patients. In addition, it induces minimal numbness. However, this study used a small number of patients and did not consider the procedure done after raising the nasal envelope.