DEAR EDITOR: The radical surgery for fungating inguinal lymph nodes is commonly done in patients with penile and vulvar cancers, creating complex groin defects. These defects are managed most commonly with either pedicled ipsilateral anterolateral thigh (ATL) flap or tensor fascia lata (TFL) flap. The reconstruction with complex flaps provide durable coverage and prevent scar contractures, which tend to form in the flexural regions such as the groin.

Introduction: Adult T-cell leukemia (ATL) is a rare neoplasm of post-thymic lymphocytes observed in only 3% - 4% of patients infected with human T-lymphotropic virus (HTLV-1). The exact mechanism by which HTLV-1 triggers ATL is still under investigation.HTLV-I is endemic in specific regions of the world including Mashhad, Iran, where the present study was performed.Case Presentation: The current paper reports serum levels of calcium, magnesium and phosphorus as the main traced elements as well as parathormone (PTH) in five patients with ATL referred to Imam Reza hospital in Mashhad, Iran, in 2014.Conclusions: We observed upper limit values of the normal range forMgin the ATL cases whichmaynot be neglected from a clinical point of view. The other measurements did not show a remarkable difference with normal levels.

Prevention and treatment of the Human T-cell leukemia virus, type 1 (HTLV-1) which was discovered nearly 40 years ago, still remain challenging. The reported high prevalence of HTLV-1 in some countries around the world triggered an open letter to the World Health Organization (WHO), urging action against HTLV-1 infection in 2018. This highlights the importance of virus elimination strategies to eradicate HTLV-1 infection. In Iran, we have documented our experiences with the virus in order to achieve and promote the possible ways to manage, control, and eliminate HTLV-1. Although there has been considerable progress apropos of HTLV-1, a series of additional challenges need to be tackled to control HTLV-1 infection in Iran.