No one involved in the planning or presentation of this activity has any relevant financial relationships with a commercial interest to disclose.
Ronald Barr, MD – Dermatopathology
Cole Fulwider, MD – Dermatology
Judith Harrison, MD – Radiation Oncology
Kenneth Linden, MD – Dermatology
Simon Madorsky, MD – Facial Plastic Surgery/ENT
Alexander Miller, MD – Dermatology
Melissa Shive, MD – Dermatology
At the completion of this activity, the learner will be able to:
- Identify characteristics of lesions that may pose an increased risk to the patient.
- Utilize the clinical and pathological data to formulate and adapt an appropriate treatment plan based on current recommendations and patient history.
- Recommend appropriate follow-up intervals to measure and evaluate the effectiveness of chosen treatments.
- Predict when sites are at an increased risk for loss of function and/or appearance.
- Summarize reconstructive techniques that can be utilized for difficult locations or large lesions.
- Recommend proper treatment or referrals.
Case #1 – Recurrent Scalp Melanoma
History: 85-year-old man with history of scalp melanoma presented with a one month rapidly growing scalp nodule. The original melanoma was treated in 2014 with original excision, then recurrence re-excision, and radiation in June 2015. The wound developed skin breakdown and osteoradionecrosis treated with serial outer table of calvarium debridements.
Biopsy on 8-1-2017 of left superior central forehead showed malignant melanoma with myxoid spindle cell features. Recent biopsy taken on 8-28-2017 showed extensive residual malignant melanoma and malignant myxoid spindle cell proliferation invading into bone, involving deep margin. Consultation report from Dr. Sharon Weiss from Emory Healthcare agreed that spindle cell component represents dedifferentiated melanoma.
Case #2 – Recurrent Melanoma
History: 70-year-old woman presents with metastatic melanoma in the right parotid gland region of one 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 right medial cheek. Original biopsy diagnosed it as a melanoma in situ in 2013. Margin excision was performed leaving the central specimen in place. When the central specimen was excised and submitted to pathology, invasive melanoma was found. The melanoma was 1.13 mm in depth without other high risk features. An upper cervical lymphadenectomy including sentinel lymph node excision found no melanoma in 2013.
Patient also has a history of multicentric BCC of upper lip treated successfully with imiquimod and PDT.
Case #3 – Multiple Atypical Nevi
History: 24-year-old woman presents with multiple atypical nevi. She has had multiple nevi excised. 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 mm benign appearing pigmented macules.
Case #4 – SCC with Atypia
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 BCC, SCC, and melanoma in situ.
Case #5 – SCC with SK clinical presentation
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. Family history is significant for melanoma in mother. Biopsy on 8-9-17 showed squamous cell carcinoma.
Case #6 – Melanoma Left Cheek
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 involved margins. Excision of melanoma in situ of left lower eyelid and cheek with additional 5mm margins was performed 8-21-17. Pathology showed no evidence of residual melanoma. There is a history of BCC excision of left cheek.
Reconstructive Cases – Additional Margin Excision after Skin Grafting