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Background Concrete, data-driven guidelines for breast cancer screening among the transgender and gender diverse (TGD) population is lacking. The present study evaluates possible associations of gender-affirming hormone therapy (GAHT) on incidental breast pathology findings in trans-masculine patients to inform decision making about breast cancer screening. Patients and Methods This was a retrospective cohort study of patients who had gender-affirming mastectomy or breast reduction at a single center from July 2019 to February 2024. A total of 865 patients met the inclusion criteria. Gender-affirming testosterone therapy and length of exposure were evaluated to seek differences in post-operative pathology findings. Results The median age at the time of surgery was 27 years [interquartile range (IQR) 21–30]. Most participants identified as female to male (658, 75.6%). A significant portion of the participants (688, 79.2%) were undergoing testosterone therapy at the time of surgery, with the median duration of testosterone use prior to surgery being 14 months (IQR 4–29). High risk or malignant findings were noted in pathology results for 12 of 1730 breasts (0.7%). Ordered logistic regression found that duration of testosterone therapy was not associated with increasing severity of incidental breast pathology. Additionally, patients under 25 years of age were 70% less likely to have any incidental finding on pathological evaluation than older patients [odds ratio (OR) 0.3, p < 0.01, confidence interval (CI) 0.18–0.50]. Conclusions The present study found that patients undergoing GAHT should not be screened for breast cancer with increased frequency compared with cis-gender women. Additionally, it may be appropriate for trans women under the age of 25 with normal breast cancer risk to forego pathological breast tissue examination.

The incidence rate for melanoma continues to rise in the USA. The majority of melanoma cases are detected at an early stage and are amenable to surgical excision. Advanced melanoma with diffuse intraabdominal metastasis is rare. We present a case of a 50-year-old female with no known primary or history of melanoma who presented with massive intraabdominal bleeding secondary to diffuse metastatic melanoma with peritoneal implants. Diagnosing metastatic melanoma could be challenging. Clinicians should be aware of hemoperitoneum or peritoneal carcinomatosis as potential manifestations of malignant melanoma to expedite appropriate management.