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Suspected cutaneous melanoma — ABIM Board MCQ

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HardDermatologySuspected cutaneous melanomaABIM Board

A 71-year-old kidney-transplant recipient has a 1.8-cm poorly differentiated cutaneous squamous cell carcinoma on the temple with perineural invasion on biopsy. There is no palpable nodal disease. Which definitive local treatment is most appropriate?

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Correct answer: C — Perform Mohs micrographic surgery with complete margin assessment

The best answer is “Perform Mohs micrographic surgery with complete margin assessment”. Immunosuppression, temple location, poor differentiation and perineural invasion make this a high-risk invasive cutaneous squamous cell carcinoma. Mohs surgery provides complete peripheral and deep margin assessment while conserving tissue in a functionally important area. Destructive or topical approaches are inadequate for this risk profile.

Reference: AAD Guideline of Care for Cutaneous Squamous Cell Carcinoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC6652228/