patient presented to request excision of a "cyst" on the upp | Figure 1

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patient presented to request excision of a "cyst" on the upper arm. Exam revealed a 1cm firm dermal nodule next two two smaller pigmented papules. Physical exam and dermoscopy not consistent with cyst. I oriented the excision to remove all three lesions and was carried down to the deep subQ fat. Path demonstrated a 7.8mm depth metastatic melanoma nodule with minimal epidermal involvement (Clarks level V). Upon being informed of the diagnosis the patient, who was a poor historian, recalled that they thought they had melanoma 10 years earlier. Patient currently undergoing metastatic workup.

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