Le MIS

 The patient is a healthy 75 to man with a biopsy proven "evolving melanoma-in-situ" on the glabella.  He has Type I skin.  First seen and biopsied in April 2020.

4.20.2020

4.21.21

Question:
Should this be excised by an oncologic surgeon, by a Mohs surgeon, or is imiquimod acceptable?

Reference: 

1.Topical Imiquimod for Lentigo Maligna: Survival Analysis of 103 Cases With 17 Years Follow-up. Meagan Chambers, et. al.  J Drugs Dermatol 2021 Mar 1;20(3):346-348. PMID

 

2. Low recurrence rates for in situ and invasive melanomas using Mohs micrographic surgery with melanoma antigen recognized by T cells 1 (MART-1) immunostaining: tissue processing methodology to optimize pathologic staging and margin assessment

Jeremy Robert Etzkorn, Christopher J Miller . J Am Acad Dermatol. 2015 May;72(5):840-50. PMID

Follow-up:
The patient underwent micrographic surgery  (with permanent sections).  With one stage the tumor was cleared.  Clinical Image 1 week post-surgery:

70 y.o. man with pre-auricular plaque

Presented by Dr. Henry Foong, Ipoh, Malaysia

The patient is a 70-yr-old man with a 2-month history of mildly pruritic skin eruption on the right preauricular area.  It has gradually increased in size and also felt "thicker" and more "lumpy".  He is otherwise in good health.

O/E shows a well demarcated hyperpigmented patch on the right preauricular area 7.5 cm x 3.0 cm.  on palpation it felt boggy. Regional nodes were not enlarged.  There was no facial nerve palsy.

 

Biopsy:

Microscopic:  Dense superficial and deep infiltrate of lymphocytes and plasma cells.  The deeper dermis shows markedly increases eosinophils. Angiolymphoid proliferation is absent as are granulomas or nerve hypertrophy.

 

Diagnosis:  My thoughts are lymphocytoma cutis versus angiolymphoid hyperplasia with eosinophila (ALHE)' but I have limited experience with these. 

Your suggestions would be appreciated.

 

Reference:

Burhan Engin, et. al. Lymphocytic infiltrations of face. Clin Dermatol. Jan-Feb 2014;32(1):101-8.
Abstract:  The immune system protects our organism and, of course, our skin from harmful factors. One of the key elements of the immune system is lymphocytes. Lymphocytes play a role in the pathogenesis of various skin diseases. Lymphocytic infiltrates are seen in many skin diseases. Some of the skin diseases characterized by lymphocytic infiltration show up in specific anatomic locations, whereas other entities can be placed in all areas of the body. The course of lymphocytic infiltrations of the face is variable and unpredictable, most often lasting from months to years. The most important diseases with lymphocytic infiltration of the face are pseudolymphomas. This review discusses various types of cutaneous pseudolymphomas and other diseases with lymphocytic infiltration mainly involving the face.