Patient Case Studies
Cerclage Closure Technique
HISTORY A 50 y/o patient presents with a 3 year h/o right cheek growing lesion biopsied by outside office on 11/8/21 showing atypical lentiginous melanocytic proliferation. Incisional biopsy of right malar cheek done on 11/18/21 showing severely atypical lentiginous junctional melanocytic hyperplasia with margins involved. Excision and reconstruction with cerclage of right malar cheek severe…
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Superficial Radiotherapy: Long Term Follow-Up of Highly Selected Basal and Squamous Cell Carcinomas in Skin Cancer Patients
Superficial radiotherapy (SRT) treatment for non-melanoma skin cancer has been reported to yield variable cure rates. When patients are highly selected, adequate margins of treatment are chosen, and hypofractionation is avoided, cure rates of SRT can approach that of Mohs surgery. SCARS Center’s research article on the subject was recently published in Journal of Dermatology…
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Chronic Open Wound Management with Wound Vac
Chronic open wounds present a lifestyle challenge for patients. In particular, lower leg wounds can take months to fully heal and may require wound care to prevent infection and maintain a healthy, healing wound. A wound vac or “vacuum-assisted closure of wound” can expedite healing. A wound vac decreases the air pressure on the wound…
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Dermaplaning and Dermabrasion to Treat Rhinophyma
BACKGROUND Rhinophyma is an uncommon form of rosacea that leads to thickening of the nasal skin and enlargement of nasal sebaceous glands. It usually occurs in men over 50. It is slowly progressive and tends to worsen over time, resulting in a bulbous shape of the nose which gradually becomes deforming. Rhinophymatous papules often form,…
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Augmenting Efficacy of Topical 5-FU for Actinic Keratoses and Skin Cancer
Diffuse actinic sun damage can present a challenge for both patients and providers. First line treatment options include topical 5-fluorouracil (5-FU) cream or photodynamic therapy (PDT). Topical 5-FU cream is applied to the affected area for 2-3 weeks creating inflammation, redness, and crusting as the body eliminates the actinic damage. Alternatively, topical levulan is applied…
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When to do Curettage and Electrodessication (C&D)
HISTORY A 95-year-old woman presents with a 4+ year history of multiple growing lesions of forehead and scalp. These were initially asymptomatic and the patient chose not to seek treatment. She did not present for evaluation and treatment until 2 of the lesions became painful and began to bleed. Shave biopsy of 2 of the…
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Wood’s Lamp Lower Eyelid Melanoma in situ
HISTORY A 57-year-old woman presents with two year hisory of right under-eye pigmentation. Shave biopsy by an outside office diagnosed MMIS, lentigo maligna type. Evaluated under Wood’s Lamp. Patient will be getting treatment at an outside office. DISCUSSION Evaluation of pigmented lesions with blue light There are multiple aspects to evaluating pigmented lesions, the most…
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Management of Invasive Squamous Cell Carcinoma Arising in Bowen’s Disease
A patient presented to the SCARS Center with a nine month history of a biopsy proven Bowen’s disease of the left second toe. Mohs surgery discovered areas of invasive squamous cell carcinoma arising from Bowen’s disease within the lesion. After completing Mohs surgery, additional deep soft tissue and phalanx bone were resected to insure tumor…
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Treatment Considerations for Melanoma In-Situ
HISTORY A 22-year-old woman presented with left upper lip lesion. Tape testing showed positive for LINC00518 and PRAME. Excisional biopsy was performed showing atypia on the preliminary results. DISCUSSION Management of melanoma in-situ can be especially challenging in cosmetically sensitive areas such as the lip. Traditional management options for melanoma in-situ include surgical excision, topical…
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Delayed Laceration Repair
Traditional approach to laceration repair dictates closure of laceration as soon as possible after an injury. Usually this involves closing the wound with stitches, staples, or skin glue within the first 24 hours. This timeline can make it difficult for the treating provider to distinguish between viable and irreversibly damaged tissue. This is particularly true…
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