A Painful Subcutaneous Nodule

Abstract

A 68-year-old man with a remote history of squamous cell carcinoma (SCC) involving the submental area presented with a slowly growing painful 2-cm subcutaneous nodule. Low-power examination (Fig. 22.1) yielded an ill-circumscribed deep dermal/subcutaneous lesion. At intermediate power (Fig. 22.2), a dense scar is seen approximating spindled cellular areas that at high-power examination (Fig. 22.3) yielded a wavy orientation typical of nerve tissue. The nerves are infiltrated and surrounded by densely chromatic cohesive cells, and in some areas dyskeratosis can be seen. Discernible inflammation is not identified.