Beyond the Surface: Chronic Lymphocytic Leukemia Diagnosis During Mohs Micrographic Surgery

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults, characterized by the accumulation of abnormal lymphocytes in the blood and bone marrow. Its incidence increases with age, typically affecting older adults, with a median age at diagnosis around 70 years. CLL prevalence varies geographically, with higher rates observed in Western countries compared to Asian populations. Despite advancements in treatment, CLL remains an incurable disease, often managed through monitoring and therapy to control symptoms and slow disease progression. The purpose of this case report is to highlight two unique incidents of previously undiagnosed CLL, incidentally found during Mohs micrographic surgery (MMS). One case features a cutaneous squamous cell carcinoma in situ and the other a basal cell carcinoma. We present these cases to highlight the importance of diagnostic vigilance during Mohs histopathological processing. Diagnosis of CLL is typically through routine complete blood panels. However, these cases present unique initial presentations that warrant careful detection in medical practice. Detecting CLL during the examination of pathology samples from MMS excision may not be common practice, but its presence emphasizes the significance of thorough patient evaluation during medical procedures. This unexpected finding underscores the importance of thorough pathology examination during surgical procedures, highlighting the potential for detecting concurrent or underlying systemic conditions. Early identification of CLL in this context allows for prompt intervention and comprehensive management, emphasizing the necessity of integrated care approaches in medical practice.