Bilateral neglected facial invasive squamous cell carcinoma in an 89-year-old man, complete excision and primary reconstruction by cervicofacial flap - case report and review of current reconstruction approaches

Sep 23, 2026

Non-melanoma skin neoplasms are increasingly common in older adults, and cutaneous squamous cell carcinoma (CSCC) typically presents as a non-healing erythematous papule, plaque, or ulcer. This case report describes a rapidly progressive, bilateral neglected facial invasive CSCC involving the parotid region in an 89-year-old man, treated with complete excision and primary reconstruction using a cervicofacial flap. A review addresses epidemiology, staging, and therapeutic management, including recurrence, metastasis risk, and the role of palliative options in selected elderly patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction and importance

Case presentation

Clinical discussion

Background

Case presentation

International Journal of Surgery Case Reports 135 (2025) 111873 Contents lists available at ScienceDirect International Journal of Surgery Case Reports journal [homepage:](homepage: www.elsevier.com/locate/ijscr)[ www.elsevier.com/locate/ijscr](homepage: www.elsevier.com/locate/ijscr) | Case report
Bilateral neglected facial invasive squamous cell carcinoma in an 89-year-old man, complete excision and primary reconstruction by cervicofacial flap, case report and review of current reconstruction approaches | | | | | --- | --- | --- | --- | | Amin Rezazadeha, Ali Samady Khanghah b,*, Sonia Sharifi Naminc
a Department of Plastic and Reconstructive Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran b Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
c Department of Pathology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran | | | | | A R T I C L E I N F O | | A B S T R A C T | | | Keywords:
Squamous cell carcinoma Parotid
Cervicofacial flap | | Introduction and importance: Non-melanoma skin neoplasms generally account for more than 80 % of occur in people in their 7th decade of life or higher, and increasing prevalence has made them a global concern. Squamous cell carcinoma (SCC) is the first step of the group of neoplasms mentioned above. An appearance of typical cutaneous squamous cell carcinoma (CSCC) is a non-healing, usually progressively enlarging erythematous papule, plaque, or ulcer. For cosmetic reasons, the surgeon should excise such lesions and then schedule second or third operations for flap-mediated reconstructions.
Case presentation: After reporting a novel case of bilateral neglected facial invasive SCC affecting the parotid region in an 89-year-old man whose treatment with a semi-therapeutic palliative approach, we have conducted areview of facial CSCC from the aspects of epidemiology, staging, and therapeutic management.
Clinical discussion: Despite mucosal SCC, cutaneous ones rarely metastasized, varying from 0.5 to 10 %. Subdividing primary cutaneous SCC into low and high-risk types has been of interest over the last decade since they behave differently regarding regional metastasis, resulting in prognosis differences. Most cutaneous SCC includes previously untreated small (less than 2 cm), thin (less than 2 mm), and well-differentiated cases.
Conclusions: The surgeons should weigh against the outcome of their approach. For instance, in the case of older people and the risk of multiple general anesthesia, a palliative approach can be considered. | | 1. Background Facial SCC is part of the head and neck squamous cell carcinoma (HNSCC) group, which includes malignancies of the oral cavity, pharynx, hypopharynx, larynx, nasal cavity, and salivary glands. It is better to approach the facial skin area with the measurements of cutaneous cancers. Non-melanoma skin cancers account for more than 80 % of occur in people aged 60 years or higher [1]. Besides aesthetic issues, the nonignorable role of organs located in the head and neck region in facilitating respiration and swallowing, as well as filtering and humidifying the air, makes HNSCC a significant health concern worldwide. The increasing incidence of HNSCC in many countries, especially among younger populations with a predicted 30 % annual increase in incidence by 2030, raises a global concern [2]. Based on an Australian series study, CSCCs commonly develop in direct sun exposure areas, with a tendency to the head and neck regions. According to this study, analyzing the anatomical distribution of 1219 head and neck CSCCs revealed the most common sites were the nose (20.0 %), cheek and maxilla (19.8 %), and ear (18.2 %) [3]. An appearance of a typical CSCCis a non-healing, usually progressively enlarging erythematous papule, plaque, or ulcer [4]. Here, we are reporting a case of a rapidly growing bilateral neglected

FAQs

What clinical presentation characterizes cutaneous squamous cell carcinoma in this report?

It presents as a non-healing, progressively enlarging erythematous papule, plaque, or ulcer, with the described case showing rapid bilateral facial progression.

How was the patient treated in the case presentation?

The lesions in the bilateral parotid regions were excised, with superficial parotidectomy and primary reconstruction performed using a tensionless Ferguson cervicofacial skin flap.

What does the discussion emphasize about metastasis risk and prognosis in CSCC?

Metastasis rates for cutaneous SCC are relatively low and prognosis differs by risk category, where dividing primary CSCC into low- and high-risk groups helps guide expectations for regional metastasis.

Sep 23, 2026

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