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Patient Case Studies

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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Wood’s Lamp Lower Eyelid Melanoma in situ

HISTORY A 57-year-old woman presents with two year hisory of right under-eye pigmentation. Shave biopsy by an outside office diagnosed MMIS, lentigo maligna type. Evaluated under Wood’s Lamp. Patient will be getting treatment at an outside office. DISCUSSION Evaluation of pigmented lesions with blue light There are multiple aspects to evaluating pigmented lesions, the most…

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Treatment Considerations for Melanoma In-Situ

HISTORY A 22-year-old woman presented with left upper lip lesion. Tape testing showed positive for LINC00518 and PRAME. Excisional biopsy was performed showing atypia on the preliminary results. DISCUSSION Management of melanoma in-situ can be especially challenging in cosmetically sensitive areas such as the lip. Traditional management options for melanoma in-situ include surgical excision, topical…

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Delayed Laceration Repair

Traditional approach to laceration repair dictates closure of laceration as soon as possible after an injury. Usually this involves closing the wound with stitches, staples, or skin glue within the first 24 hours.  This timeline can make it difficult for the treating provider to distinguish between viable and irreversibly damaged tissue. This is particularly true…

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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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Management of Non-Healing Lesion

HISTORY An 85-year-old man with a history of multiple BCC and SCC of the scalp previously treated with radiation and intralesional 5-FU presents with a non healing lesion of the left parietal scalp. Shave biopsy of the left parietal scalp performed on 7/21/21 showed a non specific ulcer with atypical squamous epithelium of the scalp.…

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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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Managing Lentigo Maligna Melanoma

HISTORY A 56-year-old man presented with complaint of lifelong history of darkening, growing left lesion of the left cheek. Biopsy on 09/24/21 showed melanoma in-situ. Excision with 5-6mm margins and closure of left cheek melanoma performed on 12/2/21 showed positive margins at 3-4 o’clock margins. Woods lamp evaluation and re-excision performed on 1/7/22. DISCUSSION Lentigo…

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