Posts by Simon Madorsky, MD
Anticoagulant Use in Cutaneous Surgery
HISTORY 87-year-old man with atrial fibrillation presented with squamous cell carcinoma in situ of scalp and forehead. Patient was treated with Mohs and reconstruction on 7-3-18. Incisional hematomas appeared 2.5 weeks post Mohs and treated with I&D. Patient continued warfarin and baby aspirin throughout treatments. DISCUSSION Anticoagulant use in Facial and Dermatologic Surgeries has become…
Read More
Leiomyoma of arm
HISTORY 74-year-old man presents with 0.6cm nodule on the posterior upper arm skin . Pathology showed atypical spindle cell neoplasm, favoring pleomorphic leiomyoma. Wide local excision was performed. DISCUSSION Leiomyoma is a tumor of smooth muscle cells. Leiomyoma of the skin usually arises from the arrector pili muscle of the hair follicles. The extent of…
Read More
Management of Recurrent Large Melanoma In Situ
HISTORY 78-year-old man presents with a recurrent melanoma in situ of left cheek in April 2018. Previously, the melanoma in situ was excised in 2001. Patient’s dermatologists performed excision in three stages over a period of 3 weeks to achieve clear margins. Reconstruction of left cheek was performed with a cheek and neck platysma myocutaneous…
Read More
Reconstructive Cases – Bilevel Grafts
DISCUSSION Nasal ala skin defects can be reconstructed with skin grafts generally with excellent results. However, deeper defects of the nasal ala repaired with a skin graft may result in a depressed deformity. Contraction of skin graft healing may also cause retraction of the nasal ala, especially with deeper defects. Adding a cartilage graft to…
Read More
Recurrent SCC of Nasal Tip
HISTORY 71-year-old man presents with recurrence of SCC of nose following Mohs excision on 2-9-17. Partial rhinectomy was performed with incomplete Mohs excision leaving residual positive margins due to patient’s comfort. Two additional excisions of involved margins were done under anesthesia achieving clear margins. First stage reconstruction was performed on 4-11-18. DISCUSSION Management of a…
Read More
Upper Chest BCC PNI
HISTORY 53-year-old man presents with a 4-year-history of BCC of upper chest. The tumor measured 12 cm x 6 cm. Wide local excision with 1 cm margins on 11/10/2017 found clear margins and perineural invasion. The nerves up to 0.23 mm were involved by tumor. The final defect was 13.5 cm x 8.3 cm. …
Read More
Multiple Nasal Basal Cell Carcinomas
HISTORY 81-year-old man presents with 7-month history of two nasal tip and right nasal ala BCC’s. All three lesions were treated with 2 adjoining SRT fields. The course began 1-8-18 and completed by 1-26-18 after 15 treatments. DISCUSSION This patient represents an excellent candidate for radiation therapy. Electron beam radiation therapy can be used with…
Read More
Large Thigh BCC Treated with Radiation
HISTORY 92-year-old man presents with 15-year history of basal cell carcinoma on left thigh. The 9.3 cm x 8.6 cm superficial plaque was treated with electron beam radiotherapy completing 6000 cGy in 30 fractions on 3-13-2018. DISCUSSION The 6-week course of radiation was tolerated well by this patient. He had minimum oozing from previous biopsy…
Read More
Pigmented BCC of Left Neck
HISTORY 81-year-old man presents with pigmented lesion on left neck. The lesion was excised with 2 mm margins. BCC was found with clear margins. DISCUSSION Pigmented basal cell carcinoma is an uncommon variant of the common skin cancer. Its behavior is that of a non-pigmented basal cell carcinoma. It can be confused with melanoma and…
Read More
Lower Lip Mucosal Defect
DISCUSSION The goals of lower lip mucosal defect reconstruction include the following: Preservation of vermillion line continuity Avoiding depressions of red lip and preserving lip fullness Preservation of red lip roll (ridge) Myomucosal island flaps help achieve all of these goals. The flaps are created laterally or medially to the defect. The island can be…
Read More