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Skin and Soft Tissue—Skin Cancer (Other than Melanoma)

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Skin and Soft Tissue—Skin Cancer

(Other than Melanoma)

Concept

Usually we are talking here about squamous cell cancer or basal cell cancer. Can consider other types of benign skin lesions in your differential, but question will be how to manage the malignant type. Basal cell is most common and may present as nodular, superficial, or ulcerating lesion.

Way Question May be Asked ?

“66 y/o male presents to office with bleeding scalp lesion.

Fungating large mass on physical exam. When patient’s hat is removed. What do you want to do?”

How to Answer?

Brief H+P

Risk factors:

(Excessive) Sun exposure Radiation

Inherited skin disorders

Physical Exam

Characteristics of lesion (size, shape, color) Full skin survey (include axillae, groin, scalp) Examine lymph node basins related to lesion

Treatment

Briefly consider DDx and then proceed to Surgical excision

Review pathology

For Squamous cell → want 5 mm margins for lesions <

2 cm in size

→ want 1 cm margin for lesions

> 2 cm in size node dissection if palpable nodes or if Margolin’s ulcer

For Basal cell → want 2 mm margins

For lesion on head/neck → would want to resect and close defect with:

(1) Free full thickness skin graft from behind ear or base of the neck

(2) Rotation flap

Mohs Surgery Indications

Recurrent basal/squamous cell CAs

Tumors of face, invasive into nasal, periorbital, periau- ricular structures

Adjuvant Treatment (XRT)

Close margins of resection (< 1 mm) Neuro/vascular invasion

BCC/SCC in medial canthus of eye/nose

Lymph Node Dissection

Only for clinically involved nodes (modified radical neck+ suparotidectomy if tumor invading parotid)

Common Curveballs

Path will come back melanoma (change scenario) Lymph nodes will be palpable

Excised lesion will recur

Lesion will be on face and needs full thickness skin graft Tumor will be large and ulcerating

There will be palpable nodes

Tumor will be preauricular invading parotid gland 107 Part 2.qxd 10/19/05 2:52 AM Page 107

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Treating a lesion that develops in chronic wound (Margolin’s ulcer)

Strikeouts

Discussing electrodessication and curettage Discussing Mohs surgery when not indicated

Discussing simply treating with radiation/chemo- therapy

Talking about SLN bxs or elective lymph node dissec- tion

108 Skin and Soft Tissue—Skin Cancer (Other than Melanoma)

Part 2.qxd 10/19/05 2:52 AM Page 108

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