In 2022-2023 mpox outbreak led to declaration of a public health emergency. Smallpox vaccination has led to increased immunity and a decrease in clinical disease. The role of vaccination in immunosuppressed patients is not well understood. We present an atypical case of cutaneous mpox, presenting in a fully vaccinated, immunosuppressed, HIV-negative patient as an initial isolated, subcutaneous neck mass. We review the diagnostic dilemma and workup for these atypical cases.