Blog Article
Dermatofibroma to Dermal Sarcoma: The Spectrum of Dermal Spindle Cell Tumors
HISTORY A 54-year-old woman with no history of skin cancers presented with 4 month h/o growing left cheek nodule. After a shave biopsy that suggested a dermatofibroma, the tumor progressed to ulceration . A 74-year-old man presented with a 2 month h/o bleeding, ulcerated nodule of left antitragus. He has a history of several skin…
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Evaluation of Longitudinal Melanonychia
HISTORY An 84-year-old woman with a history of melanoma of the left upper back presents with an 11 month h/o left great toe discoloration. Biopsy of left great toe was performed on 08/05/2019. Previous h/o discoloration of the right fifth toe was biopsied and was negative for malignancy. DISCUSSION What is the cause of melanonychia…
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Near-Infrared Laser Lymphangiography Sentinel Lymph Node Biopsy for Melanoma
HISTORY A 61-year-old male presents for 1.5 cm malignant melanoma of left posterior shoulder invading to at least 1.2 mm (Clark’s Level IV) on a shave biopsy. Left shoulder melanoma was excised, and a left axillary sentinel lymph node was biopsied. Small focus of residual melanoma was found in the primary site, but none in…
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Atypical Nevus – a Melanoma Precursor? Not Exactly
HISTORY A 27-year-old woman presented with many-year history of left cheek nevus. The lesion grew in size and changed in color. Shave biopsy showed a nevus with moderate atypical melanocytic hyperplasia. Residual pigmentation of the nevus and involved histologic margins remained after the biopsy. DISCUSSION Are all atypical melanocytic lesions pre-melanomas? Should dysplastic lesions be…
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Recurrent BCC of the External Ear After Radiation
HISTORY A 77-year-old man presents with 5-year history of infiltrative basal cell carcinoma (BCC) of the left ear fossa triangularis and root of helix. The area was originally treated with four weeks of radiation in 2014, complicated by temporary ulceration and healing with adhesion. When the area developed crusting a couple of years later, the…
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Trichoepithelioma
HISTORY 33-year-old woman presents with 3-year history of slowly growing nasal tip lesion biopsied as a trichoepithelioma. Mohs excision was performed creating a 0.6 cm defect. It was reconstructed with a lateral nasal island flap. DISCUSSION Trichoepithelioma is a benign basaloid follicular neoplasm (arising from a pilosebaceous unit). Its basal cell proliferation is differentiated from…
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Subtotal Ear Reconstruction with Alloplast
DISCUSSION Subtotal ear reconstruction is a challenging surgical task that often requires non-traditional techniques. This particular patient was treated with an alloplastic implant and rib cartilage grafts. We utilized Medpor Helical Rim implant, a porous polyethylene material (Stryker, USA) used for microtia reconstruction. The implant was used for its elegantly curved helix. The rib cartilage…
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Total Ear Reconstruction with Osseointegrated Prosthesis
DISCUSSION Total ear reconstruction after radical skin cancer resection can be treated with prosthetic rehabilitation. Optimally, osseointegrated fixation of a prosthesis is employed. This patient was treated with complete ear amputation and post-operative radiation. His prosthetic rehabilitation was a team effort between Simon Madorsky, M.D., at SCARS Center and Mark George, D.D.S., a prosthodontist. Three…
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Recurrent SCC of Nasal Tip
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
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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