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Recurrent Melanoma In Situ of Leg – Imaging Guided Excision

December 28, 2017

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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LEFT EAR MULTIPLE RECURRENT BASAL CELL CARCINOMA

December 21, 2017

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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Rhinophyma

November 13, 2017

HISTORY   65-year-old man with a history of BCC presented with a 4-year history of growing inflamed rhinophyma. First rhinophyma excision was done on 04-01-2013. Recurrence of rhinophyma resulted in the second excision and nasal planing procedure on 06-16-17. Pathology showed no evidence of malignancy.   DISCUSSION   Our approach to rhinophyma is based on…

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Chasing Margins of Melanoma In Situ of Back

November 13, 2017

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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BCC Presenting as a Back Keloid

November 13, 2017

HISTORY   80-year-old man presents with 2-year history of back nodule believed to be a keloid from a spider bite. The patient has a history of multiple basal cell carcinomas.   DISCUSSION   Biopsy showed this lesion to be a basal cell carcinoma. Moral of the story is that not all keloids or spider bites…

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

November 13, 2017

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…

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