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Posts by Simon Madorsky, MD

Mitoses in a Dysplastic Nevus

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HISTORY 61-year-old man presents with 6-month history of forehead lesion. Biopsy on October 2017 showed atypical nevomelanocytic neoplasm with several mitoses (3/mm2).  An excision with 5 mm margins was performed in November 2017 with negative findings. DISCUSSION This melanocytic tumor of uncertain malignant potential can also be called a MELTUMP. These lesions present a treatment…

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Adnexal Squamous Cell Carcinoma Recurring in Parotid

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HISTORY 74-year-old woman presents with a third occurrence of poorly differentiated carcinoma of the left cheek. Her history began in March 2015 with a 1 cm left cheek dermal poorly differentiated carcinoma. Histologic differential diagnosis included metatypical basal cell carcinoma, adnexal BCC, or metastatic epidermoid origin carcinoma. CT/PET scan was negative at the time. She…

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Myxoid Lipoma of Scalp

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HISTORY 61-year-old man presents with 40 year history of 2.5 cm mobile lipoma on left scalp vertex. Ultrasound performed on 11-14-17 revealed lipoma. Results from excision of mass showed myxoid lipoma. Consultation was obtained with Emory’s Sharon Weiss, MD, a soft tissue pathology expert.     DISCUSSION The benign myxoid lipoma should be differentiated from the malignant…

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Cerclage Closures

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DISCUSSION Cerclage closure is a relatively straightforward approach to wound repair in certain locations. Body regions with no appreciable skin creases or relaxed skin tension lines are good candidates for this technique. Regions with inherently high tension of closure is all directions, such central chest and convex shoulder, heal better with a cerclage scar versus…

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Dysplasia of Lower Lip

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HISTORY 51-year-old man presents with one-year history of lower lip nonhealing lesion. The patient has a many year history of extensive sun exposure with scaling and crusting.  A biopsy of the nonhealing lesion showed leukokeratosis with minimal keratinocytic atypia. Excisional biopsy done 11-1-17 showed moderate to focally severe squamous atypia. The patient was then treated…

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Lower Leg Wound Dehiscence

Lower Leg Wound Treatment At Scars Center

HISTORY 74-year-old man presents with BCC of left lower leg treated with Mohs excision and closure on 2-27-18. Patient presented 5 days post closure with wound dehiscence. Cutimed wound sponge dressing was used for wound management.  Debridement was performed 3-16-18. Plan is for closure with matrix xenograft.       DISCUSSION Lower leg wound dehiscence…

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Multiple Skin Cancers in an Organ Transplant Recipient

Treatment for Multiple Skin Cancer Patients

HISTORY 71-year-old organ transplant recipient presents with several SCC’s of scalp and face. Mohs excisions and closures were performed.  Tissue of the left temple incidental to reconstruction was submitted for histologic analysis. Incidental BCC was found in the specimen requiring additional treatment. 4 to 6 o’clock margin was involved.   The patient with bilateral kidney…

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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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BCC Left Upper Lip

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HISTORY 87-year-old man presents with 1 year history of lesion on left upper lip.  Biopsy taken 11-16-2017 and pathology showed basal cell carcinoma. Mohs excision and reconstruction were performed on 1-19-18. Mohs slide histology was presented for review. A question of appearance of perineural invasion was discussed.       DISCUSSION   The Mohs slides…

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Left Cheek Atypical Spitzoid Nevus

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HISTORY 23-year-old woman presents with lifelong history of left cheek mole changing recently. Biopsy in 8/2017 showed compound nevus with severe atypia with spitzoid features. Excision was performed on 2-9-18. The patient a history of atypical mole of the left back removed in 2017.       DISCUSSION   Spitz nevi are are spindle /…

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