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Patient Case Studies

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Histology

Rhinophyma

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…

Chasing Margins of Melanoma In Situ of Back

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…

BCC Presenting as a Back Keloid

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…

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

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…

Hand SCC In Situ

HISTORY 68-year-old woman presents with a many month history of squamous cell in situ of left hand. This large 2.5 cm lesion on the hand poses a unique challenge to ensuring hand function post-operatively. Treatment options include C&D (curettage and desiccation), curettage only with post-treatment imiquimod, Mohs excision with a skin graft closure, or superficial…

Twice Recurrent Upper Eyelid SCC

  HISTORY 53-year-old man presents with a recurrent upper eyelid induration and margin retraction for 3 months. Punch biopsy confirmed squamous cell carcinoma (SCC) recurrence. The first SCC excision with frozen sections and reconstruction was done 12-17-13 elsewhere. Subsequently, the eyelid was treated with LN2 in 2014 for surface AK. Carcinoma recurred at the lid…

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