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Recurrent SCC of Nasal Tip

Recurrent-SCC-nose-rhinectcomy-mapping-biopsy-SCARS-center-Mohs-excision-infiltrative-squamous-cell

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

Upper-Chest-BCC-perineural-invasion-Mohs-and-closure-SCARS-center-wide-local-excision-SRT-radiotherapy-orange-county-skin-cancer.JPG

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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Lower Lip Mucosal Defect

Lower-lip-mucosal-defect-myomucosal-island-flap-partial-island-flap-orange-county-skin-cancer

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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Left Cheek Atypical Spitzoid Nevus

Atypical-Spitzoid-Nevus-Histology-Orange-County-Skin-Cancer2

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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Melanoma In Situ of Leg – Mapping Excision Margins

Recurrent-Melanoma-In-Situ-of-Leg-Imaging-Guided-Excision-SCARS-Foundation.1

The vexing problem of positive margins after excision of melanoma in situ has many solutions. In this article, we summarize them and rank them in the order of efficacy.   Melanoma in situ excision margin guidelines range from the older 5 mm margin to the aggressive 10 mm margin of resection. 7 mm seems to…

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Red Light PDT Approval Process

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We at Skin Cancer and Reconstructive Surgery Center wanted to upgrade our Photodynamic Therapy (PDT) treatment of AK’s and superficial BCC by switching from the Blu-U light to a red light source. Red light spectrum has been shown to be a deeper penetrating light for photodynamic therapy and, thus, has gained greater worldwide acceptance –…

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PDT Across the Atlantic and Medical Economics

Scars Center - Skin Cancer Conference

Does medical economics bias the community standards for treatment of skin cancers? If the answer is yes, then photodynamic therapy serves as an illustrative example of this bias. Private practice dermatology in the US and National Health Service of UK are practice settings with significantly different economics and also different treatment goals. The one’s is…

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