Removal of Incidental Skin Cancer During Mohs Micrographic Surgery Indicated for a Different Primary Tumor.

BACKGROUND: Mohs surgery is a tissue-sparing, microscopically controlled procedure used to treat biopsy-proven skin cancers. Because Mohs surgery allows for examination of the complete margin of each tissue layer removed, separate cancers can be treated concomitantly when identified. As early detection of skin cancer is beneficial for reducing morbidity, incidental tumors discovered during Mohs surgery are of significant interest. OBJECTIVE: Our objective was to determine the prevalence and characteristics of incidental skin cancers found during Mohs surgery. METHODS: A retrospective chart review of cases seen at University of California, San Diego, from 2014 to 2021 was performed. RESULTS: Of 13,464 Mohs surgery cases, 4.53% ( n = 610) had incidental skin cancers found during removal of the initially identified tumor. Of the 610 cases, 88.4% ( n = 539) had basal cell carcinoma as the primary tumor and either squamous cell carcinoma (SCC) or SCC in situ as the incidental tumor. About 7.87% ( n = 48) had SCC as the primary tumor and basal cell carcinoma as the incidental tumor. All tumors were removed with clear margins and without significant complications. CONCLUSION: Diagnosis of incidental tumors during Mohs surgery enables early detection of skin cancer and circumvents the need for additional surgery, likely resulting in decreased morbidity and improved cost-effectiveness.

Sphenoid Sinus Giant Cell Tumor: A Case Report and Literature Review.

We describe a 27-year-old female with a giant cell tumor of her sphenoid sinus, presenting with nasal obstruction and cranial neuropathies. Both the surgical and subsequent medical management are reviewed. Additionally, we review the overall presentation, pathophysiology, and management of giant cell tumors of the skull base. Current treatment recommendations are presented.

Verrucous Sarcoidosis: A Rare Clinical Presentation of Sarcoidosis.

Verrucous sarcoidosis is a rare cutaneous variant of sarcoidosis, an inflammatory disease characterized by non-caseating granulomas that primarily involves the lungs. The current literature on verrucous sarcoidosis is limited, with the majority of lesions presenting on the lower extremities of African American males. Here, we present two cases that highlight the unique manifestations of this uncommon cutaneous entity. The first case involves a middle-aged Hispanic woman with lesions on her arms and face, and the second case involves a middle-aged African American woman with sole facial involvement. A multi-disciplinary approach to diagnosis and treatment is required as verrucous sarcoidosis can present with clinical and histopathological features indistinguishable from infectious etiologies and has an association with pulmonary sarcoidosis. Adalimumab has demonstrated success in the treatment of verrucous sarcoidosis.

Cutaneous T-cell lymphoma and concomitant atopic dermatitis responding to dupilumab.

Cutaneous T-cell lymphoma (CTCL) represents a diagnostic challenge because of its large symptomatic overlap with other common skin conditions such as atopic dermatitis (AD) and psoriasis. Dupilumab has offered promising results in AD treatment; however, concerns exist that its use may exacerbate undiagnosed CTCL. We present a patient with CTCL and concomitant AD who experienced improvement in both CTCL blood involvement and AD following the addition of dupilumab therapy.