Old-scar mass and changing surgical perspective: Sarcoidosis Sarcoidosis is a systemic inflammatory disease of an unknown etiology. Skin is involved in 25% of all cases, and 29% of them present as a scar sarcoidosis. Asymptomatic old-scar masses are generally regarded as a foreign body reaction by surgeons and often result in excisional biopsy. We describe a case of a patient who developed sarcoidosis in a 34-year-old appendectomy scar and adjacent inguinal lymph nodes without any local or systemic symptom and radiologic finding. Surgeons should not underestimate the importance of such lesions as a simple condition. Scar sarcoidosis may resolve spontaneously, or the treatment with some topical agents is effective. Furthermore, scar sarcoidosis may be the initial manifestation of systemic sarcoidosis. INTRODUCTION Sarcoidosis is a systemic inflammatory disease of an unknown etiology. It can present as involvement of multiple organs with characteristic non-caseating epithelioid cell granulomas. Exogenous antigens or autoantigens can induce cell-mediated immune responses and sarcoidosis (1). Although lung is the most commonly affected organ, the first description of the disease was associated with its cutaneous manifestation. The diagnosis of sarcoidosis is made by the clinical presentation and radiologic and his-topathologic findings, with demonstration of non-caseating granulomas. Here, we describe a case of a patient who developed sarcoidosis in a 34-year-old appendectomy scar and adjacent inguinal lymph nodes without any local or systemic symptom and radiologic finding. CASE PRESENTATION A 53-year-old woman presented to our general surgery clinic with a 1-month history of asymptomatic palpable masses in 34-year-old appendectomy scar and right inguinal region. Physical examination revealed a 3x3-cm painless mass in the old scar, and just inferior to this incision, three 1x1-cm inguinal lymph nodes were palpated (Figure 1). The patient was receiving regular colchicine therapy for a 33-year history of familial Mediterranean fever (FMF). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. Chest radiograph and high-resolution CT (HRCT) were normal. The patient denied any local or systematic symptom but painless masses. The diagnosis was considered as a foreign body reaction; the informed consent was taken, and an excisional biopsy was carried out. Histopath-ological examination showed similar findings of non-caseating granulomatoid inflammation in both the resected cicatricial mass and adjacent inguinal lymph nodes. On microscopic examination, there were multiple granulomas consisting of epithelioid macrophages and Langhans-type giant cells, with intensive lymphocytic infiltration areas between granulomas, without evidence of necrosis (Figure 2). Staining for resistant alcohol-acid bacillus (BAAR) and fungus in the specimen was negative. The final pathologic decision was scar sarcoidosis and accompanying infiltrated lymph nodes.