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Dermatopathology

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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Pigmented BCC of Left Neck

pigmented-bcc-neck-seborrheic-keratosis-orange-county-skin-cancer-pathology

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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Atypical Lymphoid Infiltrate

atypical-lymphoid-infiltrate-cutaneous-B-Cell-lymphoma-skin-cancer-orange-county

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

SCC-Scalp-Newport-Beach-Mohs-and-Reconstruction-perineural-invasion

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

Basal-cell-carcinoma-shave-excision-skin-cancer-orange-county-shave-excision-dermablade

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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Mitoses in a Dysplastic Nevus

Dysplastic-nevus-melanocytic-tumor-porcine-xenograft-island-flap2

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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Myxoid Lipoma of Scalp

myxoid-lipoma-scalp-soft-tissue-mass-skin-dermatopathology

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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Dysplasia of Lower Lip

Dysplasia-lower-lip-actinic-cheilitis-skin-cancer-SCC

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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BCC Left Upper Lip

BCC-Left-Upper-Lip-Orange-County-Skin-Cancer-Mohs-Reconstruction

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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