Mohs Case For May: Excision on the Scalp
Dr. David Roy • May 2, 2019
A 72 year-old female patient, presented to our office for treatment of a recurrent infiltrative basal cell carcinoma of her forehead. According to the patient, surgery had been attempted twice previously. Neither attempt yielded clear margins and the tumor recurred. As noted in previous blogs, this type of basal cell carcinoma is typically more aggressive than a standard nodular basal cell carcinoma and is frequently larger than it appears to be. This is why it is difficult to obtain clear margins with standard surgery.
Three stages of Mohs micrographic surgery were required to clear the tumor. The final defect involved a significant portion of the patient’s forehead (Figure 1). Luckily, the bone was not involved.
Several closure options were reviewed with the patient. Grafting was discussed, but she and her husband had significant concerns regarding the look of a graft, especially on the center of the forehead. Ultimately, the patient opted for a bilateral advancement flap. This flap had the advantage of being performed in a single stage while yielding a cosmetically pleasing result. Tissue from the lateral aspects of the forehead were elevated and moved (advanced) centrally (Figure 2).
The left side of the patient’s forehead was also rotated slightly to achieve the proper positioning. This allowed for complete closure of the wound while keeping the patient’s eyebrows level and even.
The sutures were removed after one week of healing (Figure 3).
The patient was extremely happy with the results and had no complications during the course of her healing.
This case is presented to demonstrate the severity of skin cancer, even non-melanoma skin cancers, and to highlight the skill of Pine Belt Dermatology & Skin Cancer Center in managing complex skin cancers. All of our providers take a holistic approach to treating skin cancers and pre-cancers. Our Mohs surgeon, Dr. David Roy is the only Board Certified Mohs Surgeon in the Hattiesburg, Mississippi area. Many of our competitors in the area focus on cosmetic dermatology and treatment of mild skin cancers, but our niche is management of chronic skin conditions and complex skin cancers. If you or a loved one has been diagnosed with skin cancer, there is no better dermatology group to manage it than Pine Belt Dermatology.
Skin cancer is the most commonly diagnosed cancer each year, and the Pinebelt area is significantly at risk for development due to the large agriculture and manufacturing industries in our area. May is Skin Cancer Awareness Month. Healthcare providers, even those not in the field of dermatology, will be working diligently to educate the public on the risks of skin cancer and will be urging the public to get themselves screened annually. In fact, Kristen Richardson will be hosting a “Melanoma Monday” screening on May 20th, from 9:00AM-12:00PM, at our Hattiesburg clinic
in the Merit Health Wesley hospital. This skin cancer screening is free and we encourage everyone to come by. You can get yourself booked for the screening by calling 601-475-9968!
At Pine Belt Dermatology & Skin Cancer Center, we believe education is key to protecting and maintaining healthy skin. July is significant for skin health, featuring both UV Safety Awareness Month and World Skin Health Day on July 8 . These occasions highlight the importance of sun protection and raise awareness of common concerns, such as hyperpigmentation and melasma . Understanding how ultraviolet (UV) exposure affects your skin helps prevent long-term damage and supports a healthier, more even complexion. Why UV Protection Matters The sun emits ultraviolet rays that can damage skin even on cloudy days. While many associate UV exposure with sunburn, its effects are broader. Repeated UV exposure accelerates skin aging, increases skin cancer risk, and contributes to pigmentation disorders. Common effects of excessive UV exposure include: • Sunburn and skin irritation • Premature aging, including fine lines and wrinkles • Dark spots and uneven skin tone • Increased risk of skin cancer • Worsening of hyperpigmentation and melasma Daily sun protection is one of the most effective ways to maintain healthy skin and reduce preventable damage. What Is Hyperpigmentation? Hyperpigmentation is a common condition where areas of skin become darker than the surrounding tissue due to excess melanin production. Multiple factors can contribute to hyperpigmentation, including: • Sun exposure • Acne scars and inflammation • Hormonal changes • Skin injuries or irritation • Certain medications While hyperpigmentation is mostly harmless, many seek treatment to improve skin tone as well as restore confidence. Understanding Melasma Melasma is a type of hyperpigmentation that shows up as brown or gray-brown patches, typically on the cheeks, forehead, nose, and upper lip. Melasma is frequently associated with: • Hormone changes during pregnancy • Birth control medications • Hormone replacement therapy • Genetic predisposition • Sun exposure Although melasma is not dangerous, it can be difficult to treat because UV exposure frequently triggers or worsens it. Even minimal sun exposure can increase pigment production and make discoloration more noticeable. Protecting Your Skin from UV Damage Whether you are concerned about skin cancer, hyperpigmentation, or melasma, daily sun protection is essential. Dermatologists suggest: • Using sun lotion with SPF 30 or higher every day • Reapplying sunscreen every two hours when outdoors • Wearing wide-brimmed hats and protective clothing • Seeking shade during peak sunlight hours • Wearing UV-protective sunglasses • Avoiding tanning beds Consistent sun protection helps prevent new pigmentation issues. World Skin Health Day: A Reminder to Prioritize Skin Care Observed annually on July 8, World Skin Health Day encourages preventive steps to maintain healthy skin. This is a reminder to perform regular self-exams, schedule dermatology visits, and address concerns early. If you notice persistent dark spots, changes in pigmentation, or new skin lesions, seek an expert assessment to determine the cause and identify treatment options. Supporting Healthy Skin Year-Round UV Safety Awareness Month and World Skin Health Day remind us that protecting your skin is an investment in long-term health. Practicing sun safety and understanding conditions like hyperpigmentation and melasma help preserve your skin’s health, appearance, and function. At Pine Belt Dermatology & Skin Cancer Center, our team provides personalized evaluations and treatments for pigmentation concerns, sun-damaged skin, and overall skin health. Plan a visit and learn how we can help you achieve healthier, more confident skin.
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When a ‘Rash’ Might Be Something More Serious At Pine Belt Dermatology & Skin Cancer Center, we recognize that rashes are common and frequently resolve quickly with minimal treatment. However, some rashes may signify underlying conditions that require prompt medical attention. Identifying when a rash is more than a minor irritation is key to protecting your health. Comprehending Common vs. Concerning Rashes Most everyday rashes result from irritants, allergies, heat, or minor infections and typically improve within a few days with over-the-counter treatments. However, if a rash lasts longer, worsens, or appears with other symptoms, it may signal a more serious issue. Identifying the difference between a routine rash and one that requires medical evaluation helps avoid complications and ensure appropriate care. Warning Signs to Watch For Certain features may indicate a rash requires clinical assessment, including: Rapidly spreading or worsening rash Severe pain, swelling, or blistering Signs of infection such as pus, warmth, or red streaks Fever or flu-like symptoms accompanying the rash A rash that does not improve after several days of treatment Dark, purple, or bruised-looking areas on the skin For example, a rash with fever may indicate a viral or bacterial infection, whereas painful blistering can suggest conditions such as shingles. In rare cases, rashes may signal autoimmune disorders or severe allergic reactions. Rashes That May Point to Underlying Conditions Some rashes may be linked to broader health concerns, including conditions that cause inflammation in the skin and other organs: Allergic reactions that may escalate into further severe responses Infections that spread beyond the skin if untreated Medication reactions that require immediate adjustment Persistent or unusual skin changes may be early signs of skin cancer or precancerous conditions, especially if they do not heal or continue to change over time. Why Early Evaluation Matters Delaying care for a worrisome rash may allow the underlying condition to progress. Early diagnosis improves treatment outcomes and helps prevent discomfort and complications. A dermatology specialist can assess the rash’s appearance, location, and progression, and may recommend diagnostic tests if needed. This approach assures treatment addresses the underlying cause, not just the visible symptoms. When to See a Dermatology Specialist If you are unsure about your rash, it is best to err on the side of caution. Consider seeking care if: The rash is persistent, painful, or unusual in appearance Over-the-counter treatments are not effective You experience additional symptoms such as fever or fatigue The rash interferes with your daily comfort or quality of life At Pine Belt Dermatology & Skin Cancer Center, our experienced providers supply comprehensive skin evaluations and customized treatment plans. We take time to understand your symptoms and deliver clear, effective solutions tailored to your needs. Protecting Your Skin and Your Health While many rashes are minor, some may be early warning signs of more serious health concerns. Monitoring skin changes and pursuing prompt medical advice can produce a notable effect. If you notice a rash that does not seem right, do not ignore it. Schedule a consultation with Pine Belt Dermatology & Skin Cancer Center for expert evaluation and peace of mind. Your skin is an important indicator of your overall health, and taking it seriously supports ongoing well-being.
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