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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “This is a keratowacanthoma lesion of the cheek. They're characterized by a rapid growth central ulceration and then sometimes they involute a bit. They're now classified as a low-grade squamous cell carcinoma and they're usually removed surgically. I'm going to show you the surgical excision and then I'm going to show you how we should approach the repair of the resulting defect. So this should be very interesting. Watch carefully and let me know if you have any questions. So we're going to remove this lesion.
We describe this as papular with central ulceration and this is circular so we're going to need to make it into lenticular pattern which means sort of like an ellipse with sharp edges and The question is what should the orientation be? Should we go this way? Should we go this way? Should we go at an angle? And the best way to determine that is to put the skin relaxed and see which way it wants to wrinkle. And you can see it kind of wants to wrinkle this way and those are called the relaxed skin tension lines. The other trick we can do if we're not sure which way we want to orient the incision is simply take it out as a circle and then see which way the circle wants to be oriented. If it's stretched out this way then we know the scar needs to go up and down but if it stretches out at an oblique angle horizontally then we know it needs to go that way. So what I'm going to do is take this out initially here as a circle with a margin of about 1-2mm. You're describing this as Sony I presume. Yeah. Not to me. Yeah 1-2mm. And then we'll send this to pathology to tell us what it is and that the margins are clear. And if the margins are not clear then we'll know. We need to remove a little more later. So I'll take this out at the subcutaneous adipose tissue layer here. You want to sponge that Nathan?”
Nathan: “There we go.”
Dr. Joel Aronowitz: “Well I'm sure glad you can do this for me I must say. It's been really annoying. Yeah. Nothing good is going to happen if you leave it. So there's the lesion and what I'll do is mark it with a suture in a minute. At first we'll get this under control. And I'll take that for a... Now we may need to put a deeper layer in but let's see how we do this doing something simple first.”
Nathan: “Yeah? Uh huh.”
Dr. Joel Aronowitz: “So there you have it. You notice I chased my dog ear down a little bit and then I tried to incorporate the dog ear over here in front of the ear. And now we're going to apply a bandage. I've got a dog ear. You had one. And Nathan what do we call it when we remove a dog ear? A canine auriculoplasty. Okay. So there you have it. Removal of a carotid oacanthoma type of squamous soap arsenoma. We did this five days ago.”
Nathan: “Yeah. Yeah. Monday morning.”
Dr. Joel Aronowitz: “The suture line is intact. It's nice and clean and dry. Looks very good. You having any pain from it? No. Yeah. Very good. So we'll take out probably every other suture and we'll take a look at the pathology report here. And yeah. So the pathology report shows you had what I thought you had, which is a squamous cell carcinoma. And well, it's a type of skin cancer. It's not a skin cancer that is particularly dangerous. And we'll talk about if anything more needs to be done. But it's not a melanoma or a very dangerous type of skin cancer. This is a squamous cell carcinoma.”
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