Patient Case Studies
MULTIPLE ATYPICAL NEVI WITH STRONG FAMILY HISTORY OF CANCER
HISTORY 24-year-old woman presents with multiple atypical nevi. Almost all lesions had mild atypia, few had focally moderate atypia, and one on her right posterior shoulder had severe atypia and was excised with 5mm margins elsewhere. Family history is significant for melanoma in grandmother and pancreatic cancer in her father. Physical exam showed multiple 2-4…
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ADDITIONAL MARGIN EXCISION AFTER SKIN GRAFTING
DISCUSSION This series of photographs represents an approach to margin management of melanoma in situ. Some melanoma in situ margins are difficult to assess clinically, as is the case in our first series with extensively pigmented skin. In some settings, taking 7-9 mm margins exposes the patient to significant healing issues, as the second case…
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POST FOREHEAD RECONSTRUCTION ISCHEMIC COMPLICATIONS
HISTORY 61-year-old woman underwent Mohs excision of left forehead basal cell carcinoma on 7/11/2017. Patient developed bleeding and pain post-op day 1. A subsequent polymicrobial wound infection was treated with antibiotics. Post-op hematoma is the likely contributing factor to skin flap necrosis. All ischemic tissue has self-debrided without surgical intervention. Patient is seeking reconstructive…
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EXTENSIVE NASAL TIP BASAL CELL CARCINOMA
HISTORY 71-year-old woman presents with a nasal tip lesion biopsied on 6/12/2017 showing basal cell carcinoma, superficial and micronodular type. There is a history of treatment with topical chemotherapy and Mohs excision of other sites. Patient is anxious about the possible extent of nasal carcinoma and the reconstruction required. DISCUSSION This case presents an excellent…
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Medial Canthus Repair
CHEEK FLAP ISCHEMIC COMPLICATION
HISTORY 70-year-old man with history of sarcoidosis on chronic prednisone. Left preauricular cheek squamous cell carcinoma was treated with Mohs excision and inferior SMAS partial island flap reconstruction. The healing was complicated by wound dehiscence, partially due to wound ischemia and wound tension. DISCUSSION The third case represents a dehiscence due to likely ischemia…
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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 and at least Clark’s level I with margins involved. Excision and skin graft closure performed on 8/9/2017. Pathology showed residual malignant melanoma in situ with involved margin at 2-4 o’clock. DISCUSSION Management…
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Deeply Invasive Squamous Cell Carcinoma of Cheek
HISTORY: 82-year-old man with a 1 year history of squamous cell carcinoma on the right lower cheek biopsied on 4/28/2017. Radical resection of the right cheek carcinoma and deep facial lymph node biopsy was performed. Intraoperative Mohs margin evaluation confirmed clear margins. Final permanent histology margins were close but clear. Evidence of perineural invasion…
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RECURRENT SCALP MELANOMA WITH CALVARIAL METASTASES
HISTORY 85-year-old man presented in 4/2016 with a 4 month history of a nonhealing scalp wound following excision of melanoma done in 2014, then additional excision with skin graft closure followed by radiation completed in June 2015. The wound developed skin breakdown and osteoradionecrosis treated with serial outer table of calvarium debridements. Recent biopsy on…
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LARGE FOREHEAD DEFECTS
DISCUSSION This series of large forehead defects features a frequent common theme of reconstruction. The goal of reconstruction is protection of eyebrow position and prevention of upper eyelid retraction. If tension was placed on the eyebrow with a large forehead flap, upper eyelid can suffer from a cicatricial lagophthalmos. Incomplete closure of the eyelid of…
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