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Reconstructive Techniques

Nasal-Ala-Defect-Bilevel-Skin-Graft-Orange-County-Cancer4

Reconstructive Cases – Bilevel Grafts

DISCUSSION Nasal ala skin defects can be reconstructed with skin grafts generally with excellent results. However, deeper defects of the nasal ala repaired with a skin graft may result in a depressed deformity. Contraction of skin graft healing may also cause retraction of the nasal ala, especially with deeper defects. Adding a cartilage graft  to…

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Recurrent SCC of Nasal Tip

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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Lower-lip-mucosal-defect-myomucosal-island-flap-partial-island-flap-orange-county-skin-cancer

Lower Lip Mucosal Defect

DISCUSSION The goals of lower lip mucosal defect reconstruction include the following: Preservation of vermillion line continuity Avoiding depressions of red lip and preserving lip fullness Preservation of red lip roll (ridge) Myomucosal island flaps help achieve all of these goals. The flaps are created laterally or medially to the defect. The island can be…

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Mitoses in a Dysplastic Nevus

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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Cerclage Closures

DISCUSSION Cerclage closure is a relatively straightforward approach to wound repair in certain locations. Body regions with no appreciable skin creases or relaxed skin tension lines are good candidates for this technique. Regions with inherently high tension of closure is all directions, such central chest and convex shoulder, heal better with a cerclage scar versus…

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BCC Left Upper Lip

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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Recurrent-SCC-of-Nasal-Tip-Orange-County-Skin-Cancer

Recurrent SCC of Nasal Tip

HISTORY 71-year-old man presents with recurrence of SCC of left nose. Mohs excision of left nasal tip SCC was performed on 2-9-17. Left nasal fullness under flap, initially thought to be a scar, progressed until drainage appeared. Pathology of draining debris under flap showed invasive squamous cell carcinoma.  Intranasal mapping biopsies were performed on 2-12-18.…

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Scalp Reconstruction 3

Patient diagnosed with malignant melanoma of midline forehead. Mohs excision performed by primary dermatologist. Forehead/scalp reconstruction performed by Dr. Simon Madorsky at SCARS Center.  

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