Abstract:

A 65-year-old male with no significant past medical history presented with a growing mass on his right wrist. The mass first appeared six months ago and had increased in size. The patient endorsed occasional bleeding of the lesion however denied pain. He had no history of skin cancer. Physical examination revealed a 6cm erythematous ulcerated plaque with raised borders on the right dorsal wrist. A 4mm punch biopsy of the wrist showed a central cystic portion of epithelium with a surrounding dermal scar consistent with an epidermoid cyst. Given the discordant clinical presentation, a second larger 8mm punch biopsy was performed 2 weeks later which showed multiloculated cystic spaces lined by epithelium surrounded by chronic inflammation and scar; again, consistent with an epidermoid cyst. Finally, an incisional biopsy was performed as a high clinical suspicion remained for squamous cell carcinoma (SCC). The third and final biopsy showed a central portion of eosinophilic squamous epithelium that extended into the deep reticular dermis confirming well-differentiated SCC. The patient was referred for treatment with Mohs micrographic surgery. Our case illustrates the need for subsequent biopsies of the same lesion when concerning physical examination findings and clinical suspicion are present.

Financial Disclosure:
No current or relevant financial relationships exist.

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Nikita Wong, MS