Archive for February 2022
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…
Read More
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…
Read More
A Simple Cream for Cancer with Not Always Simple Consequences
HISTORY A 62-year-old woman presents with multiple hypopigmented areas of previous skin cancer treatment with imiquimod. DISCUSSION Some patients find themselves with a large number of skin cancers and pre-cancerous lesions. While surgical excision is recommended for certain types of skin cancer, pre-cancers and superficial skin cancers can often be treated in other ways. These…
Read More
Management of Non-Healing Lesion
HISTORY An 85-year-old man with a history of multiple BCC and SCC of the scalp previously treated with radiation and intralesional 5-FU presents with a non healing lesion of the left parietal scalp. Shave biopsy of the left parietal scalp performed on 7/21/21 showed a non specific ulcer with atypical squamous epithelium of the scalp.…
Read More
Managing Eyelid Skin Cancer
HISTORY A 53-year-old man presented with an approximately 10-year history of right upper eyelid “psoriasis.” He was treated with alclometasone dipropionate 0.05% ointment which helped with redness but flaking was still present. Trial of Protopic 0.1% ointment on 1/23/20 with minimal relief. Punch biopsy of the right upper eyelid on 5/19/21 showed inflamed AK. Area…
Read More
Managing Lentigo Maligna Melanoma
HISTORY A 56-year-old man presented with complaint of lifelong history of darkening, growing left lesion of the left cheek. Biopsy on 09/24/21 showed melanoma in-situ. Excision with 5-6mm margins and closure of left cheek melanoma performed on 12/2/21 showed positive margins at 3-4 o’clock margins. Woods lamp evaluation and re-excision performed on 1/7/22. DISCUSSION Lentigo…
Read More
A Modern Test for Melanoma
DecisionDx Melanoma is enhancing medical decision making in invasive melanoma stages I, II, and III.. Management of cutaneous melanoma involves strategic risk assessment and oncologic work-up. This typically includes staging, wide local excision, and possible sentinel lymph node biopsy or biologic therapy. Traditionally, surgeons perform a sentinel lymph node biopsy (SLNB) if the possibility of…
Read More
The Rare Skin Cancers: Sebaceous Carcinomas
HISTORY A 67-year-old man presents w/ a painful right cheek scar s/p Mohs and reconstruction of sebaceous carcinoma done on 4/2019 complicated by salivary fistula. History of drained hematoma and leaking parotid gland s/p surgery. 0.3cc of kenalog 10 mg/cc injected on 9/30/21. Excision of right cheek scar with reconstruction done on 11/29/21. DISCUSSION Sebaceous…
Read More