Past medical history
His medical history was significant for cutaneous squamous cell carcinoma (cSCC) of anterior chest wall skin for which he had undergone wide local surgical excision many years ago (Figure 1). He had a local recurrence a few months prior and had undergone surgical removal with complete left axillary lymph node dissection followed by radiation therapy to the chest wall and axilla. Additionally, he had long standing hypertension that was well controlled and had undergone pulmonary vein isolation for paroxysmal atrial fibrillation 2 years prior to current symptoms. He had been maintaining sinus rhythm since his ablation but remained on apixaban.