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Non-Surgical Treatment

Augmenting Efficacy of Topical 5-FU for Actinic Keratoses and Skin Cancer

Diffuse actinic sun damage can present a challenge for both patients and providers. First line treatment options include topical 5-fluorouracil (5-FU) cream or photodynamic therapy (PDT). Topical 5-FU cream is applied to the affected area for 2-3 weeks creating inflammation, redness, and crusting as the body eliminates the actinic damage. Alternatively, topical levulan is applied…

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When to do Curettage and Electrodessication (C&D)

HISTORY A 95-year-old woman presents with a 4+ year history of multiple growing lesions of forehead and scalp. These were initially asymptomatic and the patient chose not to seek treatment. She did not present for evaluation and treatment until 2 of the lesions became painful and began to bleed. Shave biopsy of 2 of the…

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A Simple Cream for Cancer with Not Always Simple Consequences

HISTORY A 62-year-old woman presents with multiple hypopigmented areas of previous skin cancer treatment with imiquimod. DISCUSSION Some patients find themselves with a large number of skin cancers and pre-cancerous lesions. While surgical excision is recommended for certain types of skin cancer, pre-cancers and superficial skin cancers can often be treated in other ways. These…

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Managing Eyelid Skin Cancer

HISTORY A 53-year-old man presented with an approximately 10-year history of right upper eyelid “psoriasis.” He was treated with alclometasone dipropionate 0.05% ointment which helped with redness but flaking was still present. Trial of Protopic 0.1% ointment on 1/23/20 with minimal relief. Punch biopsy of the right upper eyelid on 5/19/21 showed inflamed AK. Area…

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The Rare Skin Cancers: Sebaceous Carcinomas

HISTORY A 67-year-old man presents w/ a painful right cheek scar s/p Mohs and reconstruction of sebaceous carcinoma done on 4/2019 complicated by salivary fistula. History of drained hematoma and leaking parotid gland s/p surgery. 0.3cc of kenalog 10 mg/cc injected on 9/30/21. Excision of right cheek scar with reconstruction done on 11/29/21. DISCUSSION Sebaceous…

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Severe Lichenoid Drug Eruption from Pembrolizumab

HISTORY An 88-year-old woman with a six-month history of a diffuse, pruritic eruption that includes thick, hypertrophic leg lesions with accompanying edema, ulcerations, weeping exudates and pain. The eruption started during a course of pembrolizumab (keytruda) infusions for high risk melanoma of the left great toe. Last Keytruda infusion was three months ago. DISCUSSION  Pembrolizumab,…

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Multiple Cutaneous Carcinomas in Organ Transplant Recipients

HISTORY  A 73-year-old kidney transplant recipient presented with multiple carcinomas including SCC, SCC in situ, and BCC of the face and scalp. DISCUSSION Organ transplant recipients can suffer from multiple cutaneous carcinomas. Some lesions can have a high risk of metastases, but most occur in multitudes in areas of extensive sun exposure. At SCARS Center,…

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Intralesional 5-fluorouracil for Cutaneous BCC and SCC

HISTORY  An 86-year-old man on hemodialysis with multiple medical problems and on warfarin presented with two carcinomas of the nasal tip: BCC of the left nasal tip and SCC of the right nasal tip. The ulceration of the right SCC exposed the alar cartilage. Patient completed six (6) 5-fluorouracil injections over a 5-week period. Complete…

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Nasal Open Wound Complication

HISTORY A 73-year-old man with BCC of the nasal tip presented 1 week following Mohs excision. His reconstruction was delayed for an additional week for a cardiac work up. Nasal reconstruction was performed with a superior extended nasal myocutaneous flap (SENMI flap) and nasal septal cartilage grafts. The patient developed nasal tip incisional discharge 1…

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Sentinel Lymph Node Biopsy for Cutaneous SCC

HISTORY A 58-year-old kidney transplant recipient presented with a 6-month history of squamous cell carcinoma of the left scalp. This large lesion was adjacent to the scar of a previous carcinoma excision in 2014. Patient is on sirolimus for his kidney transplant performed in 1984. He has had multiple BCCs and SCCs of scalp, back,…

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