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Patient Case Studies

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Trichoepithelioma

HISTORY 33-year-old woman presents with 3-year history of slowly growing nasal tip lesion biopsied as a trichoepithelioma. Mohs excision was performed creating a 0.6 cm defect. It was reconstructed with a lateral nasal island flap. DISCUSSION Trichoepithelioma is a benign basaloid follicular neoplasm (arising from a pilosebaceous unit). Its basal cell proliferation is differentiated from…

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Recurrent Bowen’s Disease of Temple

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

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

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

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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Subtotal Ear Reconstruction with Alloplast

DISCUSSION Subtotal ear reconstruction is a challenging surgical task that often requires non-traditional techniques. This particular patient was treated with an alloplastic implant and rib cartilage grafts. We utilized Medpor Helical Rim implant, a porous polyethylene material (Stryker, USA) used for microtia reconstruction. The implant was used for its elegantly curved helix. The rib cartilage…

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Total Ear Reconstruction with Osseointegrated Prosthesis

DISCUSSION Total ear reconstruction after radical skin cancer resection can be treated with prosthetic rehabilitation. Optimally, osseointegrated fixation of a prosthesis is employed. This patient was treated with complete ear amputation and post-operative radiation. His prosthetic rehabilitation was a team effort between Simon Madorsky, M.D., at SCARS Center and Mark George, D.D.S., a prosthodontist. Three…

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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…

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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…

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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…

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