Complex facial reconstruction after removal of giant nasal ulcerated acantholytic squamous carcinoma

Abstract

BACKGROUND. Excision of facial cutaneous carcinomas requires further reconstruction in a combined team with plastic surgeons.Among the traditional risk factors, the unprotected occupational exposure to sunlight can be identified. Giant masses at the level of the nose are frequently squamous carcinomas in origin. Moreover, repeated tumor trauma favours local-regional and remote extension. MATERIAL AND METHODS.We present step by step the surgical management of an old woman with a nasal mass of 58/36/20 mm.Also, the patient presented right genian tumefaction of approximately 6 months in evolution. RESULTS.The patient was submitted to surgical resection with free margins, leaving a considerable nasal and genian groove defect.Teaming up with the plastic surgeon, we applied complex reconstruction techniques with a satisfactory aesthetic and functional result. The histopathologic diagnosis confirmed our suspicion of an acantholytic squamous cell carcinoma with lymph nodes metastasis. CONCLUSION.Our case exhibited traditional risk factors, living in a rural environment. The tumor degree of aggressiveness was increased by repeated self-inflicted trauma. Late presentation to healthcare services implied complex facial reconstruction for the combined resection of the nasal tip and genian lymph node.