A 37-year-old male presented with a left shoulder mass that had been present for 2 years. The mass had gradually increased in size, prompting medical evaluation. He denied any pain, fever, constitutional symptoms, or flu-like symptoms. His past medical and surgical histories were unremarkable. He reported no allergy to any medication. Local examination revealed an ulcerated fungating mass over the left supraclavicular/shoulder region. The lesion measured approximately 5 cm in diameter, with an exophytic irregular surface, central ulceration, and areas of necrotic slough/crusting. The surrounding skin demonstrated erythema, induration, and inflammatory changes extending beyond the lesion margins. The lesion appeared raised and firm, with features suggestive of involvement of the underlying soft tissues. No obvious active bleeding was noted at the time of examination. The remainder of the regional examination was unremarkable.

Neck ultrasonography demonstrated a large ulcerating mass in the left supraclavicular region, extending to a depth of approximately 5 cm, with irregular surrounding tissue suggestive of local invasion, raising a high suspicion for malignancy. Multiple bilateral cervical lymph nodes, predominantly in the left cervical chain, were identified. These lymph nodes were variable in size but remained well defined, with cortical thickness <2 mm, preserved normal oval morphology, and maintained echogenic hila, consistent with benign/reactive lymph nodes. The largest cervical lymph node measured 14 × 3 mm in the left level III region. A few left axillary lymph nodes with similar benign sonographic features were also noted, the largest measuring 16 × 7 mm. The thyroid gland was normal in size and echotexture, with no focal thyroid lesions.

Fine-needle aspiration cytology (FNAC) of the left cervical and left axillary lymph nodes was performed. Cytological examination of the left cervical lymph node showed a hypercellular smear composed of a mixed population of benign lymphoid cells in a hemorrhagic background, with no evidence of malignancy. The left axillary lymph node aspirate was hypocellular but similarly demonstrated benign lymphoid cells without malignant features. Overall, the findings were negative for metastatic malignancy in both sampled lymph nodes.

The patient underwent wide local excision of the left upper shoulder mass with reconstruction using a flap under general anesthesia. The patient was positioned supine, and the left shoulder and neck region were prepared and draped in a sterile fashion. A wide local excision of the left upper shoulder mass was performed with grossly clear margins. The dissection was carried deeply, with resection extended until shaving of the clavicle to ensure adequate clearance of the tumor. Following excision, the resulting defect was reconstructed using a flap, which was mobilized and inset to achieve adequate soft tissue coverage. Hemostasis was secured, and a drain was placed. The wound was then closed in layers using appropriate sutures. The patient tolerated the procedure well and was transferred to recovery in stable condition.

Histopathological examination of the left upper shoulder skin wide local excision specimen revealed squamous cell carcinoma, not otherwise specified (NOS), grade 2 (moderately differentiated). The tumor measured 6.5 cm in greatest dimension, with a tumor depth/thickness of 3.4 cm, demonstrating invasion into the subcutaneous fat (anatomic level V). The lesion showed ulceration, lymphovascular invasion, and perineural invasion. The tumor was completely excised, with all resection margins free of tumor; the closest margin was the deep margin at 1.2 cm. Separate fragments of skeletal muscle, fibrofatty tissue, and bone were negative for tumor involvement. The pathological stage was classified as pT3.

The patient's postoperative recovery was uneventful. He remained clinically stable with satisfactory wound healing and no evidence of postoperative complications. The flap remained viable, and the surgical site showed good healing. Pain was adequately controlled, and the patient was discharged with appropriate wound care instructions and follow-up arrangements. Histopathological examination confirmed moderately differentiated squamous cell carcinoma (SCC) with clear resection margins and no regional lymph node involvement. The patient was referred to the Oncology service for further evaluation, adjuvant treatment consideration, and ongoing surveillance.