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Dermatopathology

Recurrent Bowen’s Disease of Temple

recurrent-bowens-disease-squamous-cell-carcinoma-topical-chemotherapy

HISTORY 63-year-old man presents with 9-month history of Bowen’s disease of right anterior and posterior sideburn biopsied on 08-20-18. History of previous Mohs excision of Bowen’s disease of the same area in February 2016. Patient has a history of multiple basal cell carcinomas, squamous cell carcinomas, and melanoma. DISCUSSION Management of this lesion is best…

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Scleromyxedema Cutaneous Lesions

scleromyxedema-cutaneous-lesions-dermatopathology-spindle-cell-basal-cell-carcinoma

HISTORY 87-year-old man with underlying scleromyxedema and history of multiple basal cell carcinomas presents with a left earlobe nodule. Biopsy revealed this to be a lesion with benign spindle cell proliferation in vague concentric whorls with associated dermal fibrosis and chronic inflammation. This was a typical scleromyxedema lesion presenting within the fatty earlobe and not…

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Cystic Squamous Cell Carcinoma of Forearm Skin

cystic-squamous-cell-carcinoma-of-forearm-keratoacanthoma-dermatopathology

HISTORY 74-year-old man presents with 3-month history of painful lesion of the right forearm.  Biopsy found cystic squamous cell carcinoma with deep margins involved. Wide local excision was performed achieving clear margins. DISCUSSION Cystic degeneration within squamous cell carcinoma of the skin is not considered an especially malignant finding. These histologic findings may represent changes…

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Sebaceous Nevus of Jadassohn

sebaceous-nevus-of-jadassohn-orange-county-skin-cancer-histomicrograph

HISTORY 21-year-old male presents with 10-year history of left cheek lesion that has become more prominent with puberty and thickened over time.  An excision found sebaceous nevus of Jadassohn. DISCUSSION – Nevus Sebaceous These congenital skin lesions are often excised. Timing and rationale of excision are based on the science behind the nevus sebaceous. Congenital…

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Leiomyoma of arm

leiomyoma-complete-excision-sarcoma-leiomyosarcoma-skin-cancer-orange-county-pathoogy

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…

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Management of Recurrent Large Melanoma In Situ

melanoma-in-situ-serial-excisions-mohs-excision-platysma-myocutaneous-flap-mapping-biopsy-orange-county-skin-cancer

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…

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Recurrent SCC of Nasal Tip

Recurrent-SCC-nose-rhinectcomy-mapping-biopsy-SCARS-center-Mohs-excision-infiltrative-squamous-cell

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…

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Upper Chest BCC PNI

Upper-Chest-BCC-perineural-invasion-Mohs-and-closure-SCARS-center-wide-local-excision-SRT-radiotherapy-orange-county-skin-cancer.JPG

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.  …

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Pigmented BCC of Left Neck

pigmented-bcc-neck-seborrheic-keratosis-orange-county-skin-cancer-pathology

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…

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Atypical Lymphoid Infiltrate

atypical-lymphoid-infiltrate-cutaneous-B-Cell-lymphoma-skin-cancer-orange-county

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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