SDPA Summer | Live Blog | Challenging Cases in Surgical Dermatology
Saturday morning began with a lively discussion of challenging cases in surgical dermatology. Dr. Roger Ceilley initiated the talk with a review of melanoma in situ. He stated that there is a great deal of literature that supports the recommended 5mm margins may not be enough to clear lentigo maligna and melanoma in situ of the head and neck. Dr. Ceilley described the staged excision technique that he utilizes in this practice for these lesions while Dr. Rajiv Nijhawan and Dr. Leonard Goldberg discussed the use of Mohs in the removal of these lesions with MART 1 staining. Further discussion of treatment for melanoma in situ lesions included imiquimod in the non-surgical patient or as an adjunct in difficult to clear lesions.
Next, the discussion turned to challenging basal cell carcinomas cases. Dr. Nijhawan illustrated a large basal cell tumor of the nasal bridge on a patient who had been treated with Vismodegib. Research has found that some basal cell tumors have a mutation that make these tumors resistant or at least not fully responsive to Vismodegib. Further, a few case studies have been published revealing squamous cell carcinoma development in patients taking Vismodegib for not yet understood reasons. Dr. Nijhawan recommends close surveillance of these patients every 3 months.
Christy Kerr, PA-C, gave a thorough case presentation of a challenging case of DFSP on the frontal scalp in a young female. Due to the high recurrence rate of DFSPs, this patient will need to be monitored closely for recurrence. Finally challenging squamous cell carcinoma and microcystic adnexal carcinomas were highlighted. Dr. Ceilley recommends providers have a low threshold to biopsy for any patient who complains of pain after removal of a squamous cell cancer to rule out perineural invasion.
Byline: Sarah Patton, PA-C, MSHS
Posted: June 3, 2017
Key Words: surgical dermatology, roger ceilley, rajiv nijhawan, leonard Goldberg, sdpa, society of dermatology physician assistants, summer conference, san diego