Posts Tagged ‘Mohs and reconstruction’
Trichoepithelioma
HISTORY 33-year-old woman presents with 3-year history of slowly growing nasal tip lesion biopsied as a trichoepithelioma. Mohs excision was performed creating a 0.6 cm defect. It was reconstructed with a lateral nasal island flap. DISCUSSION Trichoepithelioma is a benign basaloid follicular neoplasm (arising from a pilosebaceous unit). Its basal cell proliferation is differentiated from…
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Anticoagulant Use in Cutaneous Surgery
HISTORY 87-year-old man with atrial fibrillation presented with squamous cell carcinoma in situ of scalp and forehead. Patient was treated with Mohs and reconstruction on 7-3-18. Incisional hematomas appeared 2.5 weeks post Mohs and treated with I&D. Patient continued warfarin and baby aspirin throughout treatments. DISCUSSION Anticoagulant use in Facial and Dermatologic Surgeries has become…
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Recurrent SCC of Nasal Tip
HISTORY 71-year-old man presents with recurrence of SCC of nose following Mohs excision on 2-9-17. Partial rhinectomy was performed with incomplete Mohs excision leaving residual positive margins due to patient’s comfort. Two additional excisions of involved margins were done under anesthesia achieving clear margins. First stage reconstruction was performed on 4-11-18. DISCUSSION Management of a…
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Cutaneous B-Cell Lymphoma of the Ear
HISTORY 49-year-old woman presents with a shiny pink papule of the left ear helix. Histology found atypical lymphoid infiltrate suspicious for a cutaneous B cell lymphoma. The area was treated with Mohs excision and closure. DISCUSSION Primary cutaneous lymphoma is a low-grade and most-common B-cell lymphoma of the skin. These are primary tumors of…
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SCC of Scalp
HISTORY 86-year-old man presents with 3-month history of a mass in the left occipital scalp. 1 year prior, the patient underwent Mohs excision of a large scalp SCC. FNA biopsy on 1-22-18 found atypical squamous cells. CT PET scan showed cancer limited to the mass itself with no lymph node enhancement. Patient experienced progressively increasing…
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Cerclage Closures
DISCUSSION Cerclage closure is a relatively straightforward approach to wound repair in certain locations. Body regions with no appreciable skin creases or relaxed skin tension lines are good candidates for this technique. Regions with inherently high tension of closure is all directions, such central chest and convex shoulder, heal better with a cerclage scar versus…
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Multiple Skin Cancers in an Organ Transplant Recipient
HISTORY 71-year-old organ transplant recipient presents with several SCC’s of scalp and face. Mohs excisions and closures were performed. Tissue of the left temple incidental to reconstruction was submitted for histologic analysis. Incidental BCC was found in the specimen requiring additional treatment. 4 to 6 o’clock margin was involved. The patient with bilateral kidney…
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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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