A Day In Dermatology with Dr PimplePopper
Case #1 Full thickness skin graft to right plantar thumb. Donor site: Scrotum This patient of mine had a work-related accident many years ago and sheared the skin from his right thumb. The surgeon he saw decided to transplant tissue from his scrotal sac to the area. This is a staged surgical repair, meaning that his thumb needed to be attached to his pubic area for two weeks to ensure survivability of the graft before it was detached. As you can see the skin grafted to his thumb maintains the characteristics of the donor skin. There is hair growing from the area, and when the temperature drops, there is shrinking of the tissue. He does report his thumb “feels crazy” when the skin gets cold. I’m not really sure why the surgeon chose to graft tissue from his pubic area. This pubic area is indeed an area where skin is removed to cover defects on the hand, but usually over bends/joints, because this skin is more “stretchable”. However, on his thumb in this area, not much stretch is required, so go figure… However, it is a great conversation piece, and he is such a good sport to show all of us! Case #2 Biopsy of irritated mole on the left occiput of the scalp and removal of some skin tags / acrochordon on the upper back. These are “snip excisions” when I use a sharp serrated scissor to remove these fleshy growths. The serrations in the scissors are important because they help to grab very “dodgy” tissue. You can also see the mole microscopically here. This is a benign intradermal nevus. Case #3 A myxoid cyst, or digital mucous cyst, is actually not a true cyst, so it’s also called a pseudocyst. They are growths that most often occur on the top (dorsal) part of the finger or toe, just behind the base of the nail. They are kind of translucent/see-through, round, and slightly compressible. They are due to a connection to the joint space, where one bone meets another, the part of your finger or toe that allows you to bend the digit. The fluid inside this cyst is gel-like and sticky, because this is the lubrication that “oils” our joints. This fluid somehow has made its way closer to the surface of the skin, creating this bump. These are benign growth, and may spontaneously disappear, but recurrence is common, mainly because in order to prevent these, you may likely need to seal off this connection with the joint space. I can remove these in the office but it is not always done definitely, there is a high chance of reoccurrence, so I recommended that she see a hand surgeon who can seal the connection between this cyst and the joint space. Case#4 A milium extracted on the forehead. Case#5 An epidermoid cyst that was removed from the chest of one of my patients. I decided not to film the procedure, but thought I would show you a close up of what the cyst looks like! Case #6 This patient had a growth on her finger that she jokingly called her “wedding ring”. It is a kind of skin cancer, a type of squamous cell carcinoma, called a keratoacanthoma. They often grow up pretty quickly, like a volcano and you can see that this is what this growth looks like on her hand. I removed it during her visit, via Mohs micrographic skin cancer surgery and sutured the area closed primarily. Case #6 Large keloid on occipital scalp. This patient has a keloid that has been bothering him for quite a while. We had been softening and flattening it up with intralesional corticosteroid injections, but now he is changing jobs and can no longer wear a hat to hide the bump so he really wanted it to be removed. It’s too large to be removed via surgical excision with suture, and I worry that this may just trigger the keloid to return, at an even larger size. So I opted to shave the area off as you see here. There is still a high chance for recurrence, but hopefully this gentleman will stick with appointment to have the area injected with corticosteroids to hopefully prevent this keloid from growing back. He understands that there is a high chance of reoccurrence. We are keeping our fingers crossed.