Thirty something year old with recurrent melanoma in situ of the left cheek following excision 2 years ago with clear margins. The recurrence is a small pigmented area on one end of the scar. Additional biopsy 1.5 cm away showed scattered melanocytes determined to be melanoma in-situ.
Patient underwent additional Mohs excision of 1.5 cm diameter with finding melanoma in-situ throughout the lesion. Mohs excision achieved apparent clear margins with a 3.5 cm diameter defect. At the completion of Mohs, an additional margin was submitted for permanent histology with finding of involvement at 12-6 o’clock. The 12-6 o’clock margin was re-excised 3 days later which was found to be clear.
The 4 cm diameter cheek defect was reconstructed with inferiorly based fasciocutaneous island flap. Patient will be treated with imiquimod post-operatively.