Patient Case Studies
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…
Read MoreLeft 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 /…
Read MoreRecurrent 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.…
Read MoreLarge 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…
Read MoreMelanoma 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…
Read MoreAnkle 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…
Read MoreForehead 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…
Read MoreScalp 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…
Read MoreLeft 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…
Read MoreHand 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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