The patient, a male, presented with a large brown mole on his back about the size of the dime. His wife had brought the mole to his attention after she realized the mole had recently grown significantly and was concerned it was cancerous. Upon examination, I made an observation that led me to ask the patient if he had spent any significant time outdoors recently.
He replied that he had been hiking about a year ago, and at that moment the growth made sense. I was able to confirm that the growth on his back was not a mole, but a tick! The tick had been living on his back for the past year, feasting on blood and getting fat. It’s head was wedged in so deeply, I had to excise the flesh beneath the tick’s head in order to ensure that no part of the tick was left behind.
The patient had gone so long without realizing the tick was on his back due to two reasons. The first is, tick saliva numbs the skin, so you do not feel the initial bite or the tick burrowing beneath the skin. The second was that it’s very difficult to see your entire back in detail without a large mirror and some serious flexibility. I joked that tick bites are a hazard for single people because without his wife paying attention, he likely would not have had any idea this tick was burrowed into his skin. Another reason to always have someone watch your back (literally).