To scoop or not to scoop: the diagnostic and therapeutic utility of the scoop-shave biopsy for pigmented lesions

BACKGROUND: Concern over transection of melanomas has inhibited many practitioners from using the scoop-shave for removal of pigmented lesions. OBJECTIVE: To assess the safety and efficacy of the scoop-shave for pigmented lesions. MATERIALS AND METHODS: The practitioner\u27s clinical diagnosis, intent (sample or completely remove), and removal technique (excision, punch, shave biopsy, or scoop-shave) were recorded. Pathology results including the status of the peripheral and deep margins were subsequently documented. RESULTS: Over an 8-month period, 333 procedures were performed. Of the 11 melanomas (6 in situ and 5 invasive) removed by the scoop-shave, none had positive deep margins and 6 (2 in situ and 4 invasive) were completely removed. One of the 50 dysplastic nevi removed by scoop-shave had a positive deep margin (moderately dysplastic). Forty-six dysplastic nevi were completely removed by the scoop-shave. When the practitioner\u27s intent was complete removal, the lesion was completely removed 73.1% of the time by scoop-shave, 91% by standard excision, 18.1% by shave biopsy, and 78.6% by punch excision (p \u3c .0001). CONCLUSION: The scoop-shave is a safe and effective technique for diagnosis and treatment of melanocytic lesions

Merkel Cell Carcinoma

XI, 219 p. 86 illus., 74 illus. in color.online r

Squamous cell carcinoma tumor thrombus encountered during Mohs micrographic surgery

We present a unique case of complete vascular occlusion by squamous cell carcinoma (SCC) encountered during Mohs micrographic surgery

Columellar advancement flap for midline nasal defects

Dermatologic surgeons frequently encounter nasal tip defects after Mohs micrographic surgery. Correction of these defects presents a unique challenge. Slight flaws in design or technique may induce functional and aesthetic penalty. We present the columellar advancement flap, a novel repair option for nasal tip defects. When used appropriately, this technique results in concealed incision lines, preserved nasal symmetry, and optimal color and texture match. Additional advantages include reduction of “columellar sag” and increase of the nasolabial angle, resulting in more aesthetically pleasing nasal appearance

Failed treatment of amelanotic lentigo maligna with imiquimod followed by pigment production

A melanotic lentigo maligna (ALM) represents a small subset of lentigo maligna (LM) that lacks pigment. At least 2 cases of ALM responsive to imiquimod therapy with short-term follow-up have been reported. We report herein a case of ALM that failed to respond to imiquimod treatment. Furthermore, after therapy was initiated, the ALM began to produce pigment and transformed to LM