Surgical Surprise: Cutaneous Metastasis Presenting for Mohs Micrographic Surgery Without a Prior Diagnostic Biopsy

摘要

A 60-year-old Caucasian woman presented for Mohs micrographic surgery (MMS) after being referred for a clinically presumed basal cell carcinoma of the scalp. Three months prior, while living abroad, the patient developed a nodule on the vertex of her scalp. The patient’s primary care physician initially treated the lesion as a cyst with antibiotics. However, after no improvement, she received a second opinion and was told it was a basal cell carcinoma. The patient returned to the United States for treatment and was seen by a plastic surgeon, who subsequently referred her to a Mohs micrographic surgeon. Upon presentation, the patient had a 1.7-cm violaceous, slightly scaly nodule on the vertex of the scalp (Figure 1).