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Posts by Simon Madorsky, MD

Reconstructive Cases – Bilevel Grafts

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DISCUSSION Nasal ala skin defects can be reconstructed with skin grafts generally with excellent results. However, deeper defects of the nasal ala repaired with a skin graft may result in a depressed deformity. Contraction of skin graft healing may also cause retraction of the nasal ala, especially with deeper defects. Adding a cartilage graft  to…

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Recurrent SCC of Nasal Tip

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HISTORY 71-year-old man presents with recurrence of SCC of nose following Mohs excision on 2-9-17. Partial rhinectomy was performed with incomplete Mohs excision leaving residual positive margins due to patient’s comfort.  Two additional excisions of involved margins were done under anesthesia achieving clear margins. First stage reconstruction was performed on 4-11-18. DISCUSSION Management of a…

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Upper Chest BCC PNI

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HISTORY 53-year-old man presents with a 4-year-history of BCC of upper chest.  The tumor measured 12 cm x 6 cm. Wide local excision with 1 cm margins on 11/10/2017 found clear margins and perineural invasion. The nerves up to 0.23 mm were involved by tumor. The final defect was 13.5 cm x 8.3 cm.  …

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Multiple Nasal BCCs

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HISTORY 81-year-old man presents with 7-month history of two nasal tip and right nasal ala BCC’s. All three lesions were treated with 2 adjoining SRT fields. The course began 1-8-18 and completed by 1-26-18 after 15 treatments. DISCUSSION This patient represents an excellent candidate for radiation therapy. Electron beam radiation therapy can be used with…

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Large Thigh BCC Treated with Radiation

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HISTORY 92-year-old man presents with 15-year history of basal cell carcinoma on left thigh. The 9.3 cm x 8.6 cm superficial plaque was treated with electron beam radiotherapy completing 6000 cGy in 30 fractions on 3-13-2018. DISCUSSION The 6-week course of radiation was tolerated well by this patient. He had minimum oozing from previous biopsy…

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Pigmented BCC of Left Neck

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HISTORY 81-year-old man presents with pigmented lesion on left neck. The lesion was excised with 2 mm margins. BCC was found with clear margins. DISCUSSION Pigmented basal cell carcinoma is an uncommon variant of the common skin cancer. Its behavior is that of a non-pigmented basal cell carcinoma. It can be confused with melanoma and…

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Lower Lip Mucosal Defect

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DISCUSSION The goals of lower lip mucosal defect reconstruction include the following: Preservation of vermillion line continuity Avoiding depressions of red lip and preserving lip fullness Preservation of red lip roll (ridge) Myomucosal island flaps help achieve all of these goals. The flaps are created laterally or medially to the defect. The island can be…

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Atypical Lymphoid Infiltrate

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HISTORY 49-year-old woman presents with a shiny pink papule of the left ear helix. Histology found atypical lymphoid infiltrate suspicious for a cutaneous B cell lymphoma. The area was treated with Mohs excision and closure.   DISCUSSION Primary cutaneous lymphoma is a low-grade and most-common B-cell lymphoma of the skin. These are primary tumors of…

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SCC of Scalp

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HISTORY 86-year-old man presents with 3-month history of a mass in the left occipital scalp. 1 year prior, the patient underwent Mohs excision of a large scalp SCC.  FNA biopsy on 1-22-18 found atypical squamous cells. CT PET scan showed cancer limited to the mass itself with no lymph node enhancement. Patient experienced progressively increasing…

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Shave excision of Lower Extremity Carcinomas

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HISTORY 67-year-old woman presents with 3 BCCs on right lower extremity diagnosed on shave biopsies.  Superficial shave excisions of the carcinomas left close margins within 0.1 mm. Second set of shave excisions found no residual carcinoma.     DISCUSSION Lower leg skin carcinomas are often superficial and can be treated with superficial treatments. This patient’s…

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