Lymphoepithelioma-like carcinoma of the skin (LELCS) is an exceedingly rare tumour with similar morphologic and pathologic features to nasopharyngeal carcinoma. Metastatic potential is low with only 6 cases reported in the English literature. Incidental identification of non-melanoma neoplasms at sentinel lymph node biopsy (SLNB) is a rare but reported phenomenon with incidence estimated at 1%. We present a case of a 66-year-old male presenting for left arm melanoma wide local excision and axillary SLNB. His history included LELCS of the left hand widely excised one year prior. SLNB was negative for melanoma but revealed 3 clinically occult nodes positive for LELCS. The patient received adjuvant axillary radiotherapy and remains in remission. This case adds to the current literature for this rare tumour and highlights the possibility for incidental findings at SLNB, a procedure frequently performed by Plastic Surgeons.