Posts by Simon Madorsky, MD
EXTENSIVE NASAL TIP BASAL CELL CARCINOMA
HISTORY 71-year-old woman presents with a nasal tip lesion biopsied on 6/12/2017 showing basal cell carcinoma, superficial and micronodular type. There is a history of treatment with topical chemotherapy and Mohs excision of other sites. Patient is anxious about the possible extent of nasal carcinoma and the reconstruction required. DISCUSSION This case presents an excellent…
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Medial Canthus Repair
CHEEK FLAP ISCHEMIC COMPLICATION
HISTORY 70-year-old man with history of sarcoidosis on chronic prednisone. Left preauricular cheek squamous cell carcinoma was treated with Mohs excision and inferior SMAS partial island flap reconstruction. The healing was complicated by wound dehiscence, partially due to wound ischemia and wound tension. DISCUSSION The third case represents a dehiscence due to likely ischemia…
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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 and at least Clark’s level I with margins involved. Excision and skin graft closure performed on 8/9/2017. Pathology showed residual malignant melanoma in situ with involved margin at 2-4 o’clock. DISCUSSION Management…
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Deeply Invasive Squamous Cell Carcinoma of Cheek
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…
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RECURRENT SCALP MELANOMA WITH CALVARIAL METASTASES
HISTORY 85-year-old man presented in 4/2016 with a 4 month history of a nonhealing scalp wound following excision of melanoma done in 2014, then additional excision with skin graft closure followed by radiation completed in June 2015. The wound developed skin breakdown and osteoradionecrosis treated with serial outer table of calvarium debridements. Recent biopsy on…
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LARGE FOREHEAD DEFECTS
DISCUSSION This series of large forehead defects features a frequent common theme of reconstruction. The goal of reconstruction is protection of eyebrow position and prevention of upper eyelid retraction. If tension was placed on the eyebrow with a large forehead flap, upper eyelid can suffer from a cicatricial lagophthalmos. Incomplete closure of the eyelid of…
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Metastatic Squamous Cell Carcinoma
HISTORY 76-year-old man with a rapidly growing mass on angle of jaw. Fine needle aspiration on 12/6/16 diagnosed squamous cell carcinoma. The presumptive primary carcinoma was skin. On 12/16/16, the patient underwent a left parotidectomy and cervical lymphadenectomy. Pathology showed multiple lymph node involvement. Radiation and concurrent chemotherapy treatment began on 1/18/2017 and was completed…
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Calvarial Invasion of scalp SCC
HISTORY 72-year-old man presents with an ulcerating skin lesion on the right scalp. In March 2013, a biopsy showed pleomorphic sarcoma and the histologic differential diagnosis included atypical fibroxanthoma and malignant fibrous histiocytoma. In May 2013, Mohs excision and additional resection of the outer table of the calvarium was completed. In April 2016, a new…
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Aggressive Forehead SCC
History 78-year-old man with a recurrence of squamous cell carcinoma of forehead following surgery and radiation. Resection was performed in 4/2016 and radiation followed. Lesion recurred within 1 week of completion of radiation within radiation field. Originally presented with squamous cell carcinoma with perineural invasion and 4.5mm depth of invasion, arising from squamous cell carcinoma…
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