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Patient Case Studies

Large BCC of Thigh


Basal Cell Carcinoma BCC Pathology Xstrahl 100 SRT machine with a 10 cm applicator and a custom lead shield   Penumbral calculation Source: HISTORY   92-year-old man presents with 15 year history of basal cell carcinoma on left thigh. The cancer is now a 9.3 cm x 8.6 cm superficial plaque with a few…

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Melanoma within recurrent MIS


Resection margins of melanoma in situ. Reconstruction of the cheek portion of the defect with a nasolabial fold island advancement flap, reconstruction of the nasal alar component with a skin graft. Recurrent invasive melanoma 6 years later. HISTORY   73-year-old woman presents with 1-year history of recurrent pigmented lesion of the right nasal ala  found to be…

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Ankle Ganglion Cyst


HISTORY   51-year-old man presents with a 7-year history of an right ankle subdermal soft mass that has been recently growing. Fine needle aspiration found benign fibrous tissue in myxoid-like material consistent with a ganglion cyst.   DISCUSSION   This case serves as a reminder that not all subcutaneous tissue is dermatologic in origin. Ganglion…

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Forehead SCC with Perineural Invasion


Radiation Fields – beam’s eye view above, isodose curves below for main field (left) and a boost (right) HISTORY   83-year-old man presented in 02/2017 with a 3-year history of a forehead and temple SCC. The cancer was initially treated with cryoablation and 5-FU. Excision on 9/2/16 was performed with residual circumferential margins. Histology found…

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Scalp SCC Metastasis to Neck


HISTORY   64-year-old man presents in 11/2017 with tender, right postauricular swelling. Fine needle aspiration biopsy showed squamous cell carcinoma. Extensive squamous cell carcinoma of scalp was treated with 4 levels of Mohs earlier that year in 01/2017. Additional smaller squamous cell carcinoma of the same area of the scalp was treated with Mohs in…

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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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Left Ear Multiple Recurrent Basal Cell Carcinoma


HISTORY   64-year-old woman presents with recurrence of left ear basal cell carcinoma.  She has a history of sun lamp tanning  and scuba diving with multiple sun burns. Basal cell carcinoma was first removed from left scapha and treated with a skin graft in July 2009. The area subsequently developed crusting and was treated with…

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Hand SCC In Situ

HISTORY 68-year-old woman presents with a many month history of squamous cell in situ of left hand. This large 2.5 cm lesion on the hand poses a unique challenge to ensuring hand function post-operatively. Treatment options include C&D (curettage and desiccation), curettage only with post-treatment imiquimod, Mohs excision with a skin graft closure, or superficial…

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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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BCC Presenting as a Back Keloid


HISTORY 80-year-old man presents with 2-year history of back nodule believed to be a keloid from a spider bite. The patient has a history of multiple basal cell carcinomas.   DISCUSSION Biopsy showed this lesion to be a basal cell carcinoma. Moral of the story is that not all keloids or spider bites are what…

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