This asymptomatic lesion had developed insidiously on the foreleg of an 82-year-old woman. She had a history of multiple non-melanoma skin cancers, most likely related to extensive sun exposure throughout life.
The 2.2 x 1.5-cm nodule was rockhard with a thick, scaly crust. Inguinal lymph nodes were not enlarged.
A biopsy of the lesion showed invasive squamous cell carcinoma without obvious perineural involvement. The patient was referred for excision with staged microscopic control (Mohs surgery). The lesion was removed after 3 sequential step excisions, and the defect closed primarily.
The patient was pleased with the cosmetic outcome. She remains under close observation for possible recurrence and for skin cancer in general.