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Post by Mike Inskip on Dec 29, 2015 18:00:34 GMT -5
58 year old man who has worked outdoors in Victoria Australia for > 40 years in farming & road construction.
Here's the histology report from the lesion R lower lateral lip
CLINICAL NOTES:
3mm punch biopsy clinical squamous cell carcinoma right lower lip.
SPECIMEN:
Right lower lip: A 3mm core of skin 4mm deep. Processed whole.
MICROSCOPY:
The punch has come from a markedly acanthotic lesion showing focal
moderate parakeratin production with some mild atypia. In the lower
layers of expanded epidermis there is marked keratinocytic atypia and
evidence of invasion with a fibroblastic and inflammatory reaction
related to the invasive component. The features are those of a
moderately differentiated invasive squamous cell carcinoma.
DIAGNOSIS:
Right lower lip, punch biopsy: Features of an invasive moderately
differentiated squamous cell carcinoma.
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Post by Mike Inskip on Dec 29, 2015 18:03:55 GMT -5
I'm having trouble uploading images. System not very user friendly . Any tips ?
Mike Inskip
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Post by Roman Bronfenbrener on Dec 29, 2015 18:31:39 GMT -5
Hey Mike, try pressing "Add image to post" and then uploading the images. It only lets me do one at a time for now!
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Post by Mike Inskip on Dec 29, 2015 19:22:11 GMT -5
  Errrrr not sure that helped ? |
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Post by Mike Inskip on Dec 29, 2015 19:24:07 GMT -5
Oooooh yeah it worked. Anyway I'll be doing a wedge excision in the next hour or two so I'll post some more images then.
Mike
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Post by Roman Bronfenbrener on Dec 29, 2015 19:30:27 GMT -5
Yes that worked perfectly. Please post the follow-up.
The benefit of this approach is that you can upload an unlimited amount of photos at original resolution. So it should always be easy to zoom in appropriately and attach the size photo that will be most useful. I still want to work on some things before sending it out to make it a little more streamlined
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Post by Roman Bronfenbrener on Dec 29, 2015 19:31:30 GMT -5
Doesn't look like his orifice would be much smaller with that approach  |
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Post by Mike Inskip on Dec 29, 2015 23:08:32 GMT -5
Here he is with wedge marked  |
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Post by Mike Inskip on Dec 29, 2015 23:09:33 GMT -5
.... and with full thickness wedge excised.......  |
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Post by Mike Inskip on Dec 29, 2015 23:10:19 GMT -5
....and at the end of procedure.  |
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Post by Roman Bronfenbrener on Dec 29, 2015 23:21:46 GMT -5
Nice work! Do you do prophylactic antibiotics here because you violated the mucosal barrier?
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Post by Mike Inskip on Dec 30, 2015 0:49:40 GMT -5
Not routinely. I give the patient a 'standby script' to use if there are signs of infection.
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Post by Mike Inskip on Dec 30, 2015 21:27:03 GMT -5
Just by coincidence I saw this 71 year old lady as a new patient this AM. She has a significantly larger clinical SCC in a similar location.   She says she will be OK for this to be done under LA so I'll do this here next week using a similar method. This time I can try to conceal the scar in the lateral commissure crease. |
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Post by Roman Bronfenbrener on Dec 30, 2015 21:39:05 GMT -5
maybe also a good location for an abbe flap, if you ever do those?
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Post by Dr Mike Inskip on Dec 30, 2015 23:40:51 GMT -5
I confine myself to simple wedge excisions - sometimes with the W modification for broader midline lesions.
The main limitation is the patient has to keep still and not talk for 30- 40 mins during the procedure under LA. It is surprising how many folks simply cannot do this and thus get referral for sedation / GA.
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