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Patient Case Studies

Leiomyosarcoma of Scalp

HISTORY An 84-year-old man presented with a 7-month history of 2.5 cm ulcerated nodule of the scalp. Biopsy showed a poorly defined neoplasm consistent with a leiomyosarcoma. Wide local resection with 1 cm margins cleared the tumor. The 5 cm scalp defect was reconstructed with multiple large scalp rotation flaps. DISCUSSION Spindle cell neoplasms of…

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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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Lethal Squamous Cell Carcinoma of the Forearm in a Lung Transplant Recipient

HISTORY A 71-year-old lung transplant recipient presented with a recurrence of left dorsal forearm and wrist Squamous Cell Carcinoma (SCC) after Mohs excision in 2016 performed elsewhere. The patient underwent Mohs excision with clear margins and additional deeper wide local resection with no carcinoma identified. Patient was referred for radiation oncology evaluation, but he was…

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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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recurrent-bowens-disease-squamous-cell-carcinoma-topical-chemotherapy

Recurrent Bowen’s Disease of Temple

HISTORY 63-year-old man presents with 9-month history of Bowen’s disease of right anterior and posterior sideburn biopsied on 08-20-18. History of previous Mohs excision of Bowen’s disease of the same area in February 2016. Patient has a history of multiple basal cell carcinomas, squamous cell carcinomas, and melanoma. DISCUSSION Management of this lesion is best…

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Scleromyxedema Cutaneous Lesions

HISTORY 87-year-old man with underlying scleromyxedema and history of multiple basal cell carcinomas presents with a left earlobe nodule. Biopsy revealed this to be a lesion with benign spindle cell proliferation in vague concentric whorls with associated dermal fibrosis and chronic inflammation. This was a typical scleromyxedema lesion presenting within the fatty earlobe and not…

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Cystic Squamous Cell Carcinoma of Forearm Skin

HISTORY 74-year-old man presents with 3-month history of painful lesion of the right forearm.  Biopsy found cystic squamous cell carcinoma with deep margins involved. Wide local excision was performed achieving clear margins. DISCUSSION Cystic degeneration within squamous cell carcinoma of the skin is not considered an especially malignant finding. These histologic findings may represent changes…

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sebaceous-nevus-of-jadassohn-orange-county-skin-cancer-histomicrograph

Sebaceous Nevus of Jadassohn

HISTORY 21-year-old male presents with 10-year history of left cheek lesion that has become more prominent with puberty and thickened over time.  An excision found sebaceous nevus of Jadassohn. DISCUSSION – Nevus Sebaceous These congenital skin lesions are often excised. Timing and rationale of excision are based on the science behind the nevus sebaceous. Congenital…

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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-skin cancer-orange-county

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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