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Desmoplastic / Spindle Cell Melanoma of the Scalp

A 67-year-old man with CLL presents with 3 month h/o 3 cm dense dermal growing scalp mass. Incisional biopsy showed spindle cell melanoma. The tumor was resected with a 2 cm margin. Final pathology showed malignant melanoma—spindle cell / desmoplastic type. Additional 1.2 cm margin was resected for wide clearance creating a 10 x 9…

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Dermatofibroma to Dermal Sarcoma: The Spectrum of Dermal Spindle Cell Tumors

HISTORY A 54-year-old woman with no history of skin cancers presented with 4 month h/o growing left cheek nodule. After a shave biopsy that suggested a dermatofibroma, the tumor progressed to ulceration . A 74-year-old man presented with a 2 month h/o bleeding, ulcerated nodule of left antitragus. He has a history of several skin…

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Evaluation of Longitudinal Melanonychia

HISTORY An 84-year-old woman with a history of melanoma of the left upper back presents with an 11 month h/o left great toe discoloration. Biopsy of left great toe was performed on 08/05/2019. Previous h/o discoloration of the right fifth toe was biopsied and was negative for malignancy. DISCUSSION What is the cause of melanonychia…

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Intralesional 5-fluorouracil for Cutaneous BCC and SCC

HISTORY  An 86-year-old man on hemodialysis with multiple medical problems and on warfarin presented with two carcinomas of the nasal tip: BCC of the left nasal tip and SCC of the right nasal tip. The ulceration of the right SCC exposed the alar cartilage. Patient completed six (6) 5-fluorouracil injections over a 5-week period. Complete…

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Nasal Open Wound Complication

HISTORY A 73-year-old man with BCC of the nasal tip presented 1 week following Mohs excision. His reconstruction was delayed for an additional week for a cardiac work up. Nasal reconstruction was performed with a superior extended nasal myocutaneous flap (SENMI flap) and nasal septal cartilage grafts. The patient developed nasal tip incisional discharge 1…

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Sentinel Lymph Node Biopsy for Cutaneous SCC

HISTORY A 58-year-old kidney transplant recipient presented with a 6-month history of squamous cell carcinoma of the left scalp. This large lesion was adjacent to the scar of a previous carcinoma excision in 2014. Patient is on sirolimus for his kidney transplant performed in 1984. He has had multiple BCCs and SCCs of scalp, back,…

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Near-Infrared Laser Lymphangiography Sentinel Lymph Node Biopsy for Melanoma

HISTORY A 61-year-old male presents for 1.5 cm malignant melanoma of left posterior shoulder invading to at least 1.2 mm (Clark’s Level IV) on a shave biopsy. Left shoulder melanoma was excised, and a left axillary sentinel lymph node was biopsied. Small focus of residual melanoma was found in the primary site, but none in…

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Atypical Nevus – a Melanoma Precursor? Not Exactly

HISTORY A 27-year-old woman presented with many-year history of left cheek nevus. The lesion grew in size and changed in color. Shave biopsy showed a nevus with moderate atypical melanocytic hyperplasia. Residual pigmentation of the nevus and involved histologic margins remained after the biopsy. DISCUSSION Are all atypical melanocytic lesions pre-melanomas? Should dysplastic lesions be…

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Pediatric Office Procedures with PRO-NOX™ Nitrous Oxide

HISTORY An 8-year-old girl presents with a 1 year history of dark mole of the right lower eyelid. Initially presenting as a small freckle, it grew and darkened in color. Right lower eyelid excisional biopsy was performed utilizing PRO-NOX™ nitrous oxide system. Biopsy showed intradermal nevus, combined type (primarily a common blue nevus and a…

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