Posts by Simon Madorsky, MD
Cutaneous B-Cell Lymphoma of the Ear
HISTORY 49-year-old woman presents with a shiny pink papule of the left ear helix. Histology found atypical lymphoid infiltrate suspicious for a cutaneous B cell lymphoma. The area was treated with Mohs excision and closure. DISCUSSION Primary cutaneous lymphoma is a low-grade and most-common B-cell lymphoma of the skin. These are primary tumors of…
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SCC of Scalp
HISTORY 86-year-old man presents with 3-month history of a mass in the left occipital scalp. 1 year prior, the patient underwent Mohs excision of a large scalp SCC. FNA biopsy on 1-22-18 found atypical squamous cells. CT PET scan showed cancer limited to the mass itself with no lymph node enhancement. Patient experienced progressively increasing…
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Shave excision of Lower Extremity Carcinomas
HISTORY 67-year-old woman presents with 3 BCCs on right lower extremity diagnosed on shave biopsies. Superficial shave excisions of the carcinomas left close margins within 0.1 mm. Second set of shave excisions found no residual carcinoma. DISCUSSION Lower leg skin carcinomas are often superficial and can be treated with superficial treatments. This patient’s…
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Mitoses in a Dysplastic Nevus
HISTORY 61-year-old man presents with 6-month history of forehead lesion. Biopsy on October 2017 showed atypical nevomelanocytic neoplasm with several mitoses (3/mm2). An excision with 5 mm margins was performed in November 2017 with negative findings. DISCUSSION This melanocytic tumor of uncertain malignant potential can also be called a MELTUMP. These lesions present a treatment…
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Adnexal Squamous Cell Carcinoma Recurring in Parotid
HISTORY 74-year-old woman presents with a third occurrence of poorly differentiated carcinoma of the left cheek. Her history began in March 2015 with a 1 cm left cheek dermal poorly differentiated carcinoma. Histologic differential diagnosis included metatypical basal cell carcinoma, adnexal BCC, or metastatic epidermoid origin carcinoma. CT/PET scan was negative at the time. She…
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Myxoid Lipoma of Scalp
HISTORY 61-year-old man presents with 40 year history of 2.5 cm mobile lipoma on left scalp vertex. Ultrasound performed on 11-14-17 revealed lipoma. Results from excision of mass showed myxoid lipoma. Consultation was obtained with Emory’s Sharon Weiss, MD, a soft tissue pathology expert. DISCUSSION The benign myxoid lipoma should be differentiated from the malignant…
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Cerclage Closures
DISCUSSION Cerclage closure is a relatively straightforward approach to wound repair in certain locations. Body regions with no appreciable skin creases or relaxed skin tension lines are good candidates for this technique. Regions with inherently high tension of closure is all directions, such central chest and convex shoulder, heal better with a cerclage scar versus…
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Dysplasia of Lower Lip
HISTORY 51-year-old man presents with one-year history of lower lip nonhealing lesion. The patient has a many year history of extensive sun exposure with scaling and crusting. A biopsy of the nonhealing lesion showed leukokeratosis with minimal keratinocytic atypia. Excisional biopsy done 11-1-17 showed moderate to focally severe squamous atypia. The patient was then treated…
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Lower Leg Wound Dehiscence
HISTORY 74-year-old man presents with BCC of left lower leg treated with Mohs excision and closure on 2-27-18. Patient presented 5 days post closure with wound dehiscence. Cutimed wound sponge dressing was used for wound management. Debridement was performed 3-16-18. Plan is for closure with matrix xenograft. DISCUSSION Lower leg wound dehiscence…
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Multiple Skin Cancers in an Organ Transplant Recipient
HISTORY 71-year-old organ transplant recipient presents with several SCC’s of scalp and face. Mohs excisions and closures were performed. Tissue of the left temple incidental to reconstruction was submitted for histologic analysis. Incidental BCC was found in the specimen requiring additional treatment. 4 to 6 o’clock margin was involved. The patient with bilateral kidney…
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