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Melanoma

Desmoplastic / Spindle Cell Melanoma of the Scalp

A 67-year-old man with CLL presents with 3 month h/o 3 cm dense dermal growing scalp mass. Incisional biopsy showed spindle cell melanoma. The tumor was resected with a 2 cm margin. Final pathology showed malignant melanoma—spindle cell / desmoplastic type. Additional 1.2 cm margin was resected for wide clearance creating a 10 x 9…

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Evaluation of Longitudinal Melanonychia

HISTORY An 84-year-old woman with a history of melanoma of the left upper back presents with an 11 month h/o left great toe discoloration. Biopsy of left great toe was performed on 08/05/2019. Previous h/o discoloration of the right fifth toe was biopsied and was negative for malignancy. DISCUSSION What is the cause of melanonychia…

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Near-Infrared Laser Lymphangiography Sentinel Lymph Node Biopsy for Melanoma

HISTORY A 61-year-old male presents for 1.5 cm malignant melanoma of left posterior shoulder invading to at least 1.2 mm (Clark’s Level IV) on a shave biopsy. Left shoulder melanoma was excised, and a left axillary sentinel lymph node was biopsied. Small focus of residual melanoma was found in the primary site, but none in…

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Melanoma within recurrent MIS

HISTORY   73-year-old woman presents with 1-year history of recurrent pigmented lesion of the right nasal ala  found to be invasive melanoma with 0.5 mm invasion. Patient’s history began 9 years ago in 2009 with excision of a melanoma in situ and skin graft closure. In 2012, pigmentation adjacent to the graft site was found…

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Scalp Reconstruction 3

Patient diagnosed with malignant melanoma of midline forehead. Mohs excision performed by primary dermatologist. Forehead/scalp reconstruction performed by Dr. Simon Madorsky at SCARS Center.  

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Chin Reconstruction 3

Patient diagnosed with Melanom-In-Situ of left chin. Mohs excision performed at primary dermatologist’s office. Chin reconstruction performed by Dr. Simon Madorsky at SCARS Center. 

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Eyelid Reconstruction 4

Patient diagnosed with 0.8 mm invasive melanoma with involved deep margins. Mohs surgery performed by Dr. Matthew Goodman at SCARS Center. Eyelid reconstruction performed by Dr. Simon Madorsky at SCARS Center.  

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Melanoma In Situ of Leg – Mapping Excision Margins

The vexing problem of positive margins after excision of melanoma in situ has many solutions. In this article, we summarize them and rank them in the order of efficacy.   Melanoma in situ excision margin guidelines range from the older 5 mm margin to the aggressive 10 mm margin of resection. 7 mm seems to…

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Mapping of Recurrent Melanoma In Situ of Leg

HISTORY   50-year-old woman presents with recurrent melanoma in situ of left leg. First biopsied on 9-2-16, the lesion was excised on 10-14-16 and showed extensive residual melanoma in-situ with radial margins involved from 12- 3 o’clock.  The defect was reconstructed at the time with a full thickness skin graft. Second excision cleared the involved…

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Right Ear Melanoma in Situ - Treatment

Right Ear Melanoma In Situ with Depth Uncertainty – The role of Histopathologic Discordance in Clinical Decision Making

HISTORY 40-year-old man presents with a 2 month history of right posterior ear pigmented papule. Shave biopsy on 9-18-17 showed malignant melanoma at least in situ. Excision with 5 mm margins on 10-9-17 confirmed residual melanoma at least in situ with clear margins. DISCUSSION Lack of superficial invasion cannot be definitely ruled out after a…

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