Question

OPERATIVE REPORT

Patient Name: Jose Vergara                                                                                                                                      MR#: 000-513

Attending Physician: James Czaikovski, M.D.                                                                                                        Room #: 202

Surgeon: J. Hyung Lee, M.D.                                                                                                                                   Date: 10/14/10

Preoperative Diagnosis: Multiple basal cell carcinoma temporal right lower lid.

Anesthesia: Local.

Operation: Pentagonal full-thickness excision of multiple basal cells right lower lid. Right lateral canthoplasty [surgical repair of the canthus].

Procedure: The patient, a 28-year-old Hispanic male, was brought to the operating room and placed in the supine position. Under nasal prong oxygen and cardiac monitoring, the right lower lid and surrounding area were anesthetized. The right face was prepped in the routine manner. The head and body were draped to expose the right eye.

Two, approximately 1.5–2.0 mm, round nodular ulcers centrally cratered, indurated lesions were outlined on the right lower lid not extending above the lateral canthal line. Medial to these lesions was a large milium [keratin-filled cyst]. A pentagonal incision was outlined incorporating approximately 1 cm of lid margin. A horizontal lateral canthotomy [surgical division of the slit between the eyelids] was made, and the tissue below it was undermined. The pentagonal incision, with the base being the lid margin, was then excised by outlining with mosquito forceps followed by scissors excision. Hemostasis was achieved with bipolar cautery. The lateral canthal flap was further undermined, and the lateral canthal skin incision was extended approximately 0.5 cm temporally. The medial lid margin was then sutured to the lateral canthal ligament. The horizontal incision of the lateral canthotomy was closed, and pentagonal lid gap was closed. Tobradex ointment and Telfa pad was placed and ice applied.

The patient tolerated the operation well and left the operating room in satisfactory condition.

PATHOLOGY REPORT

Clinical Data: Rule out malignancy, lesion of eyelid.

Diagnosis: Basal Cell Carcinoma.

Specimen Site: Eyelid.

Gross Description: The specimen is received in formalin and labeled with the patient’s name. It consists of a 0.1 cm punch biopsy of light-tan, wrinkled skin excised to a depth of 0.2 cm. On the surface, there is an irregularly pigmented area measuring 0.1 cm. Entirely submitted.

Microscopic Description: Sections of the submitted skin biopsy show a multicentric basal cell carcinoma. The tumor is formed by masses of small, darkly basophilic, ovoid cells that tend to palisade around the periphery. Marked basophilic degeneration of collagen is seen in the dermis. There is focal lymphocytic infiltration of the dermis. The tumor extends to margins of the biopsy.

Discussion Questions

1.     What is basal cell carcinoma?

2.     How does it compare with malignant melanoma?

3.     The report states that there is “focal lymphocytic infiltration of the dermis.” Focal here means limited to a specific area. Use your medical terminology skills to determine the meaning of lymphocytic.

4.     What do the suffixes used in canthotomy and canthoplasty indicate is being done to the canthus (the inner or outer corner of the eye)?

Answer 1

1. Basal cell carcinoma is a carcinoma of skin involving the basal cells of skin.

these basal cells are present in epidermis of skin and they help in generation of new cells.

Basal cell carcinoma mainly occurs in the face.

2.

Malignant melanoma	Basal cell carcinoma
Arises from melanocytes	Arises from basal cells
Spreads to other part of the body	Unlikely to spread other parts of the body
Occurs anywhere on The body	Mostly on the face
Arises from moles.	Lesion will be transluscent

3. Lymphocytic means inflammation of skin which is infiltrated with lymphocytes.

4. canthotomy - suffix is Otomy

means surgical incisions into the canthus.

canthoplasty - suffix is plasty

means repair or restoration of function of the canthus by surgical.