Patient Case Studies
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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Chasing Margins of Melanoma In Situ of Back
HISTORY 69-year-old man presents with melanoma in situ of the upper back. A biopsy on 6/15/2017 showed malignant melanoma at least in-situ. Excision with 5 mm margin and skin graft closure on 8/9/2017 found residual melanoma in situ with at 2-4 o’clock. Additional 4mm margin excision on 9-13-17 still found residual lesion at 1-3…
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Diagnosis change: AFX to Pleomorphic Sarcoma of Neck
HISTORY 93-year-old man presents with an incidentally discovered left neck mass during evaluation of a left ear SCC. Initial biopsy on 9-5-17 showed atypical fibroxanthoma. Excision of the left neck lesion with 5 mm margins on 9-26-17 revealed malignant spindle and epithelioid cell neoplasm consistent with pleomorphic dermal sarcoma. Deep and peripheral margins were involved.…
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Twice Recurrent Upper Eyelid SCC
HISTORY 53-year-old man presents with a recurrent upper eyelid induration and margin retraction for 3 months. Punch biopsy confirmed squamous cell carcinoma (SCC) recurrence. The first SCC excision with frozen sections and reconstruction was done 12-17-13 elsewhere. Subsequently, the eyelid was treated with LN2 in 2014 for surface AK. Carcinoma recurred at the lid margin…
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INFLAMED SK APPEARING AS SQUAMOUS CELL CARCINOMA
HISTORY 57-year-old woman with 40-year history of growth on right mid back that has changed in color and size. This is a 2.2cm rough plaque with variable colors. Previous biopsy done 15-20 years ago was benign. Patient has a history of BCC and SCC. Biopsy was read as a squamous cell carcinoma by a dermatologist.…
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LOWER LIP ATYPIA AT MARGINS OF SQUAMOUS CELL CARCINOMA
HISTORY 89-year-old man presents with several month history of lesion on bottom lip. A biopsy was taken on 8-9-17 and showed severe squamous atypia without ruling out deeper SCC. Excision of lesion done 9-6-17 showed invasive squamous cell carcinoma with foci of moderate squamous dysplasia from 9 to 3 o’clock. Patient has history of…
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RECURRENT MELANOMA
HISTORY 70-year-old woman presents with metastatic melanoma in the right parotid gland region of 1 year duration. Diagnosis was made with a core needle biopsy on 09-08-17. Patient also has small palpable right cervical lymph nodes with SUV 1.6 and 2.0. Patient history of melanoma began in 2001 as a pink macule of the…
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RECURRENT SCALP MELANOMA WITH CALVARIAL METASTASES
HISTORY 85-year-old man with history of treated scalp melanoma presented with a 1 month rapidly growing scalp nodule. The original melanoma was treated in 2014 with excision, then re-excision of recurrence, and post-operative radiation in June 2015. The wound developed skin breakdown and osteoradionecrosis and was treated with serial outer table of calvarium debridement. Biopsy…
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CHEEK AND EYELID RECONSTRUCTION WITH MULTIPLE PARTIAL ISLAND FLAPS
HISTORY 61-year-old woman presents with several year history of pigmented left cheek and lower lid lesion. She was initially treated with liquid nitrogen 15 months ago. A biopsy was performed 6-8-17 and revealed melanoma in situ. Excision with close margins performed 6-16-17. Clear margins found on LPMG reading. Second opinion from UCSD was suspicious for…
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