title: Multiple subclinical syringomatous proliferations encountered during Mohs surgery for basal cell carcinoma.
abstract: BACKGROUND
  Examination of Mohs surgery frozen sections may lead to discovery of incidental benign neoplasms such as syringomas.
  
  
  OBJECTIVE
  An unusual occurrence of numerous subclinical syringomatous proliferations discovered during Mohs surgery for a basal cell carcinoma that posed a diagnostic and management dilemma is reported.
  
  
  METHODS
  Clinical records and histologic sections are examined.
  
  
  RESULTS
  Multiple syringomatous proliferations were noted around a basal cell carcinoma during Mohs surgery. A few foci were atypical appearing and focally extending into the deep dermis causing a diagnostic dilemma. All atypical syringomatous proliferations were excised. Evaluation of final Mohs margins by permanent sections and biopsies of normal-appearing facial skin showed multiple benign syringomas.
  
  
  CONCLUSIONS
  Although solitary subclinical syringomas have been described in association with basal cell carcinomas, the occurrence of multiple syringomas and syringomatous proliferations has not been previously reported. Dermatologists should be aware of the existence of this phenomenon and consider permanent section evaluation to better determine nature of unusual incidental tumors identified in frozen sections during Mohs surgery.
authors.affiliation: Department of Dermatology, Presbyterian Hospital of Cornell University, New York, New York 10022, USA.
authors.forename: Snehal P
authors.initials: SP
authors.lastname: Amin
authors.forename: Alysa R
authors.initials: AR
authors.lastname: Herman
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Busam
authors.forename: Dana L
authors.initials: DL
authors.lastname: Sachs
authors.forename: Kishwer S
authors.initials: KS
authors.lastname: Nehal
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery*; D003937:Diagnosis, Differential; D005153:Facial Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013544:Sweat Gland Neoplasms / Q000473:pathology* / Q000601:surgery*; D018252:Syringoma / Q000473:pathology* / Q000601:surgery*