History

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  History of sun exposure.

  
  
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  Personal or family history of skin cancer.

  
  
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  Genetic conditions: Xeroderma pigmentosum, Gorlin (nevoid basal cell) syndrome, albinism.

Physical examination

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  Full-body integument examination.

  
  
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  Lymph node examination.

Diagnostic studies

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  If patient presents initially without resection, a biopsy should be performed at the time of evaluation to establish a diagnosis.

  
  
  
  
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    Full-thickness incisional versus excisional biopsies may be performed. Avoid shave biopsies.

Excision (see Table 6.1)

Reconstruction

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  Should be delayed until negative margins are confirmed on final pathology.

  
  
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  Local wound care or temporizing skin graft in interim.

  
  
  
  
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    Fresh frozen pathologic evaluation cannot ensure negative margins.