Reflectance confocal microscopy is a niche modality for micro mapping of cutaneous cancers. It uses laser scanning of an area of 0.8 x 0.8 cm. The scanning takes anywhere from 10 to 20 minutes with larger areas requiring multiple scans and taking even longer. Reflectance confocal microscopy can easily detect basal cell carcinomas within the dermis as well as atypical melanocytes and squamous cell carcinomas. It is a form of noninvasive mapping biopsy. This mapping of cancer can predict the extent of Mohs surgery or limit the extent of radiation fields necessary to treat a skin 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…Read More
S-100, tyrosinase, Melan A, and HMB 45 have been the workhorses of melanocyte histopathology. A new immunohistochemical stain, SOX10, has recently been shown to be a useful marker in the diagnosis of melanocytic tumors. It is strongly expressed by desmoplastic melanoma and is less likely to be expressed by background fibrocytes and histiocytes. (review article)…Read More
HISTORY: 82-year-old man with a 1 year history of squamous cell carcinoma on the right lower cheek biopsied on 4/28/2017. Radical resection of the right cheek carcinoma and deep facial lymph node biopsy was performed. Intraoperative Mohs margin evaluation confirmed clear margins. Final permanent histology margins were close but clear. Evidence of perineural invasion…Read More
HISTORY 85-year-old man presented in March 2015 with a multi-year history of a non-healing right lower leg lesion. Shave biopsy found squamous cell carcinoma in situ with focal areas of early invasion. Superficial radiotherapy was prescribed at 50 kvp 5 days per week for 5 weeks ending in July 2015. Minor skin erosion present 3…Read More
Peri-auricular subcutaneous lesions can be deceptive. These neoplasms have a higher risk of being non-dermal-related tumors than neoplasms of other areas of the face. Attempts at excision without consideration of a differential diagnosis can often lead to tumor compromise. Over the last several months, SCARS Center has treated several tumors previously excised partially by other…Read More
HISTORY 57 year old woman presented with a 6 month history of a dense nodule in the subcutaneous malar cheek. Biopsy on 3/31/2017 revealed a foreign body reaction granuloma with polarizable foreign body. Kenalog injection of the mass was performed a few months before without improvement. There is no history of Sculptra or other fillers…Read More
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