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Dermatopathology

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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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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Large BCC of Thigh

Skin-Cancer-And-Reconstructive-Surgery-Foundation-Large-BCC-of-Thigh-3

HISTORY   92-year-old man presents with 15 year history of basal cell carcinoma on left thigh. The cancer is now a 9.3 cm x 8.6 cm superficial plaque with a few ulcerations.  Patient is being evaluated for treatment with superficial radiation therapy.       DISCUSSION   Large  superficial basal cell carcinomas of the skin…

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Forehead SCC with Perineural Invasion

Skin-Cancer-And-Reconstructive-Surgery-Foundation-Forehead-SCC-with-perineural-invasion-Beam’s-eye-view

HISTORY   83-year-old man presented in 02/2017 with a 3-year history of a forehead and temple SCC. The cancer was initially treated with cryoablation and 5-FU. Excision on 9/2/16 was performed with residual circumferential margins. Histology found poorly differentiated sclerosing squamous cell carcinoma, with perineural invasion of 0.1 mm nerves.  Wide local resection with radial…

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Scalp SCC Metastasis to Neck

Skin-Cancer-And-Reconstructive-Surgery-Foundation-Scalp-SCC-Metastasis-to-neck-CT-PET-scan

HISTORY   64-year-old man presents in 11/2017 with tender, right postauricular swelling. Fine needle aspiration biopsy showed squamous cell carcinoma. Extensive squamous cell carcinoma of scalp was treated with 4 levels of Mohs earlier that year in 01/2017. Additional smaller squamous cell carcinoma of the same area of the scalp was treated with Mohs in…

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Left Ear Multiple Recurrent Basal Cell Carcinoma

Skin-Cancer-And-Reconstructive-Surgery-Center-Foundation-Left-Ear-Multiply-Recurrent-Basal-Cell-Carcinoma

HISTORY   64-year-old woman presents with recurrence of left ear basal cell carcinoma.  She has a history of sun lamp tanning  and scuba diving with multiple sun burns. Basal cell carcinoma was first removed from left scapha and treated with a skin graft in July 2009. The area subsequently developed crusting and was treated with…

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Right Ear Melanoma In Situ with Depth Uncertainty – The role of Histopathologic Discordance in Clinical Decision Making

Right Ear Melanoma in Situ - Treatment

HISTORY 40-year-old man presents with a 2 month history of right posterior ear pigmented papule. Shave biopsy on 9-18-17 showed malignant melanoma at least in situ. Excision with 5 mm margins on 10-9-17 confirmed residual melanoma at least in situ with clear margins. DISCUSSION Lack of superficial invasion cannot be definitely ruled out after a…

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