The importance of palpation in the skin cancer screening examination

Abstract

Prior to widely available testing, the coronavirus 2019 pandemic led to adapted triage and management plans for patients with skin cancer in unprecedented ways, with conversion of faceto-face (F2F) visits to virtual visits and delayed treatment of semiurgent dermatologic indications such as basal cell carcinoma (BCC).While prompt treatment is important, prior literature has demonstrated that delaying treatment of BCC with Mohs micrographic surgery from time of biopsy to up to 1 year is associated with potentially larger defects but not poor outcomes. 1 Having smaller defects, however, is likely to lead to better cosmetic outcomes and should be strived for when possible. Treatment delay for cutaneous squamous cell carcinoma (cSCC), on the other hand, can lead to nodal metastasis and disease-specific death, especially in immunocompromised populations. 2 We present a case of biopsy-proven cSCC on the left cheek of a man who elected to delay treatment with MMS.By time of eventual surgery, he was found to have aggressive neurotropic tumor that was detectable on deep palpation but not by visual inspection and clinical images. This case provides several clinical pearls in the evaluation and management of skin cancers, patient counseling, and it serves as an important lesson on the value of F2F examinations, especially with high-risk populations. | C A S E REP ORTAn 86-year-old-male patient with a medical history of Sezary syndrome and monoclonal B-cell lymphocytosis underwent biopsy on the left cheek which showed cutaneous squamous cell carcinoma (Figure 1A,B). He was referred for surgical intervention via MMS, not only for comprehensive margin control but also for its ability to spare

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