Melanoma
Melanoma In Situ of Leg – Mapping Excision Margins
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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Right Ear Melanoma In Situ with Depth Uncertainty – The role of Histopathologic Discordance in Clinical Decision Making
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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Chasing Margins of Melanoma In Situ of Back
HISTORY 69-year-old man presents with melanoma in situ of the upper back. A biopsy on 6/15/2017 showed malignant melanoma at least in-situ. Excision with 5 mm margin and skin graft closure on 8/9/2017 found residual melanoma in situ with at 2-4 o’clock. Additional 4mm margin excision on 9-13-17 still found residual lesion at 1-3…
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RECURRENT MELANOMA
HISTORY 70-year-old woman presents with metastatic melanoma in the right parotid gland region of 1 year duration. Diagnosis was made with a core needle biopsy on 09-08-17. Patient also has small palpable right cervical lymph nodes with SUV 1.6 and 2.0. Patient history of melanoma began in 2001 as a pink macule of the…
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RECURRENT SCALP MELANOMA WITH CALVARIAL METASTASES
HISTORY 85-year-old man with history of treated scalp melanoma presented with a 1 month rapidly growing scalp nodule. The original melanoma was treated in 2014 with excision, then re-excision of recurrence, and post-operative radiation in June 2015. The wound developed skin breakdown and osteoradionecrosis and was treated with serial outer table of calvarium debridement. Biopsy…
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CHEEK AND EYELID RECONSTRUCTION WITH MULTIPLE PARTIAL ISLAND FLAPS
HISTORY 61-year-old woman presents with several year history of pigmented left cheek and lower lid lesion. She was initially treated with liquid nitrogen 15 months ago. A biopsy was performed 6-8-17 and revealed melanoma in situ. Excision with close margins performed 6-16-17. Clear margins found on LPMG reading. Second opinion from UCSD was suspicious for…
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MULTIPLE ATYPICAL NEVI WITH STRONG FAMILY HISTORY OF CANCER
HISTORY 24-year-old woman presents with multiple atypical nevi. Almost all lesions had mild atypia, few had focally moderate atypia, and one on her right posterior shoulder had severe atypia and was excised with 5mm margins elsewhere. Family history is significant for melanoma in grandmother and pancreatic cancer in her father. Physical exam showed multiple 2-4…
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MELANOMA IN SITU OF BACK
HISTORY 69-year-old man presents with melanoma in situ of the upper back. A biopsy on 6/15/2017 showed malignant melanoma at least in-situ and at least Clark’s level I with margins involved. Excision and skin graft closure performed on 8/9/2017. Pathology showed residual malignant melanoma in situ with involved margin at 2-4 o’clock. DISCUSSION Management…
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RECURRENT SCALP MELANOMA WITH CALVARIAL METASTASES
HISTORY 85-year-old man presented in 4/2016 with a 4 month history of a nonhealing scalp wound following excision of melanoma done in 2014, then additional excision with skin graft closure followed by radiation completed in June 2015. The wound developed skin breakdown and osteoradionecrosis treated with serial outer table of calvarium debridements. Recent biopsy on…
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Osteoradionecrosis of Skull
HISTORY 85-year-old man presented in 4/2016 with a 4 month history of a nonhealing scalp wound following excision of melanoma, radiation, and two failed skin grafts. Patient was treated with serial outer table of calvarium debridements – 4/2016, 7/2016, 11/2016. Patient had a consultation with UCI team for full thickness calvarial resection and microvascular reconstruction.…
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