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Microscopic examination revealed a poorly circumscribed dermal neoplasm composed of poorly granulated, pleomorphic neoplastic mast cells with frequent cell-in-cell structures. Notably, viable neoplastic mast cells were engulfed by large macrophages, indicating a specific form of the cell-in-cell phenomenon. Immunohistochemistry for c-KIT, IBA1, and cleaved caspase-3 was used to support the diagnosis. 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