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Patient Case Studies

BCC-Left-Upper-Lip-Orange-County-Skin-Cancer-Mohs-Reconstruction

BCC Left Upper Lip

HISTORY 87-year-old man presents with 1 year history of lesion on left upper lip.  Biopsy taken 11-16-2017 and pathology showed basal cell carcinoma. Mohs excision and reconstruction were performed on 1-19-18. Mohs slide histology was presented for review. A question of appearance of perineural invasion was discussed.       DISCUSSION   The Mohs slides…

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Left Cheek Atypical Spitzoid Nevus

HISTORY 23-year-old woman presents with lifelong history of left cheek mole changing recently. Biopsy in 8/2017 showed compound nevus with severe atypia with spitzoid features. Excision was performed on 2-9-18. The patient a history of atypical mole of the left back removed in 2017.       DISCUSSION   Spitz nevi are are spindle /…

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Recurrent SCC of Nasal Tip

HISTORY 71-year-old man presents with recurrence of SCC of left nose. Mohs excision of left nasal tip SCC was performed on 2-9-17. Left nasal fullness under flap, initially thought to be a scar, progressed until drainage appeared. Pathology of draining debris under flap showed invasive squamous cell carcinoma.  Intranasal mapping biopsies were performed on 2-12-18.…

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Large BCC of Thigh

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 ulcerations.  Patient is being evaluated for treatment with superficial radiation therapy.       DISCUSSION   Large  superficial basal cell carcinomas of the skin…

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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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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

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 poorly differentiated sclerosing squamous cell carcinoma, with perineural invasion of 0.1 mm nerves.  Wide local resection with radial…

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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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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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Cancer Diagnosis Hand Squamous Cell Carcinoma in Situ

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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