Picture Gallery since I graduated medical school...
Adventure of Rick Lin DO MPH throughout his Derm Residency....
INTERN YEAR...
Fall 2001
Fall 2001
Spring 2002
Fall 2002
Spring 2003
Lost in the hall ways of UTSW
Here is my standard rap sheet...December, 2002
Presenters: Rick Lin, DO, MPH, Dan J Ladd, DO
Program Director: Bill V. Way, DO
Clinical Presentation
90 year old white male
History
Chief Complaint: A spot on the right forehead
Signs and symptoms: none
Previous Treatment: none
Other Information: Past history of basal cell carcinoma. Patient returns for a
follow up visit to be monitored for possible recurrence of Skin Cancer and to
evaluate skin for the possible development of new pre-cancers. Patient did not
know how long the spot on the right forehead had been there. The lesion is
asymptomatic.
Dermatohistopathology
Hyperkeratosis and parakeratosis with proliferation of
neoplastic squamous epithelial cells in an irregular pattern with little
tendency towards keratinization and with surrounding fibrosis and inflammatory
reaction. Immunoperoxidase stains were positive for CD68, a marker of
fibrohistiocytic differentiation and negative for cytokeratin, S-100 protein,
and HMB45 antigen.
Discussion
Atypical fibroxanthoma is a
tumor that occurs in older patients in the areas of sun exposure and/or
therapeutic radiation. The lesions clinically are suggestive of malignancy
because they are fast growing. This disease entity often leads to misdiagnosis
and results in unnecessary and extensive surgery. It is a low-grade malignancy
related to malignant fibrous histiocytoma. Because of atypical fibroxanthoma is
small in size and more superficially located, it has much better prognosis than
malignant fibrous histiocytoma. Some cases may represent primary squamous cell
carcinoma (SCC) that fails to express keratin. The tumor is often presenting as
a small, firm nodule with an eroded crusted surface.. Histologically, lesions
show a highly atypical and pleomorphic cellular appearance. The tumor consists
of spindle cells mingled with atypical histiocytes. Vesicular nuclei are located
in some spindle cells. The cytoplasm maybe vacuolated and resemble the foamy
cells of xanthomas.
They typically respond to simple excision but have a high rate of local
recurrence. For this reason Mohs surgery is the treatment of choice. Factors
important to consider are lesion location, patient age, histopathologic
appearance, and the observation that the tumor arises from the dermis, not the
fat. Metastasis is rare.
Treatment
Actual treatment for this patient:
The lesion was excised with specimen sent to pathology for confirmation. The
margins were cleared and patient was instructed to follow up for recheck in 3
months.
Other Treatment options:
Evidence is accumulating that demonstrates that Mohs micrographic surgery, with
its high reliability of complete tumor removal and tissue-conserving property,
may be the treatment of choice for atypical fibroxanthoma on certain areas of
the head and neck.
Right before the Koprince Award-Winning Lecture in Tucson Arizona in March
2004...
September 2004.... My Gravy Days..... Still 175lbs... with my diet coke diet
January of 2005.... Orlando Florida....
March 2005.. now with my Diet Pepsi Diet.... down to 160lb
The little girl who broke my heart.....
My 32nd Birthday....
One of my many acquisitions and establishments around the country... this one is at Key West... before I lost it to the tropical storm... not covered by insurance :-(
One of my many acquisitions and establishments around the country... this one is at New Orleans.. I also lost it to the tropical storm... also not covered by insurance :-(
Rick Lin's Fan Club
The time when I won the $1000 Allergan award....
Day after the completion of my residency!!!! With all my life long dermatology friends..... December 2005
The sweater made me look fat!!! I am still only 165lb.....
NOW my hair is even longer!!!!!