Secondary Primary Carcinoma Arising on the Flap Skin in the Oral Cavity - Case Series

Sep 21, 2026

Background: Oral squamous cell carcinoma (OSCC) carries substantial morbidity and mortality and remains a major global health burden. Management is multidisciplinary, with surgery and reconstruction of postablative defects as the gold standard. Secondary primary OSCC is not unusual, yet development on flap skin used for prior oral reconstruction is rare. Methods: Three cases are reported where secondary primary OSCC appeared on flap skin—two on radial forearm free flaps and two on pectoralis major regional flaps. Results: Although uncommon, secondary primary tumors may arise in the flap used for intraoral reconstruction after initial oncological treatment. No clear mechanism is explained in current literature. Conclusions: Clinicians should physically examine the flap in addition to evaluating neck metastasis or primary recurrence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Post-Excisional Defect Reconstruction and Flap Skin Changes

Case I

Case II

Case III

Discussion and Conclusions

Case Report Secondary Primary Carcinoma Arising on the Flap Skin in the Oral Cavity—Case Series Boris Kos 1, Dinko Martinovic 2, Danko Muller 3, Iva Markota 3, Zoran Karlovic 4, Josko Bozic 5 and Emil Dediol 1, * Citation: Kos, B.; Martinovic, D.; Muller, D.; Markota, I.; Karlovic, Z.; Bozic, J.; Dediol, E. Secondary Primary Carcinoma Arising on the Flap Skin in the Oral Cavity—Case Series. Diseases 2024, 12, 324. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.3390/diseases12120324](10.3390/diseases12120324) Academic Editor: Pedro Bullon Received: 18 November 2024 Revised: 8 December 2024 Accepted: 9 December 2024 Published: 12 December 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Maxillofacial Surgery, University Hospital of Dubrava, 10000 Zagreb, Croatia 2 Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia 3 Department of Pathology, University Hospital of Dubrava, 10000 Zagreb, Croatia 4 School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia 5 Department of Pathophysiology, School of Medicine, University of Split, 21000 Split, Croatia * Correspondence: [emildediol@gmail.com](emildediol@gmail.com) Abstract: Background: Oral squamous cell carcinoma (OSCC) causes considerable morbidity and mortality rates, posing a major global health burden. The management of the OSCC is multidisciplinary, but still the gold standard is surgical resection and reconstruction of the postablative defect. The appearance of secondary primary OSCC is not uncommon; however, it is quite rare that it appears on the skin of the flap that was used for reconstruction during the previous surgical therapy. Methods: We present three cases in which a secondary primary OSCC appeared on the skin of two radial forearm free flaps and two on regional pectoralis major flaps. Results: Our case series show that, although relatively rare, there is a chance of a secondary primary tumor on the flap used for intraoral reconstruction after the first oncological reconstruction. According to the latest and available literature, there is still no explanation of the underlying mechanism that leads to this occurrence. Conclusions: The learning point of this case series should be that, aside from the neck metastasis or recurrence of the primary oral cancer, the clinicians should also bear in mind that the flap itself should be physically examined in detail. Keywords: oral squamous cell carcinoma; secondary primary carcinoma; head and neck 1. Introduction Oral squamous cell carcinoma (OSCC) is the sixth most widespread malignancy in the world and the most frequent malignancy among head and neck cancers [1] . Due to its sensitive location as well as considerable morbidity and mortality rates with which it is associated, OSCC is a major global health burden. While there are many etiological causes that contribute to the development of OSCC, tobacco and alcohol remain the most important risk factors [2,3] . In recent decades there were certain advances regarding the management of OSCC, especially regarding the surgical reconstruction of the post-excisional defect, but still the primary gold standard for the treatment of OSCC is the radical resection along with the dissection of the cervical lymph nodes [4] . Depending on the staging of the disease, usually an adjuvant chemoradiotherapy follows after the surgical management. According to the literature, the 5-year survival rate of OSCC is moving from 40% to 70%, depending on the author [5–8] . The goal of post-excisional defect reconstruction using regional or, more recently, free flaps is to recov

FAQs

What does the case series describe about secondary primary carcinoma?

It describes rare secondary primary OSCC arising on the flap skin used for intraoral reconstruction, rather than only as neck metastasis or recurrence.

How many cases were included and what flap types were involved?

Three cases were included, with lesions occurring on two radial forearm free flaps and two regional pectoralis major flaps.

What are the proposed explanations for secondary primary OSCC on flap skin?

The report discusses possibilities such as chronic inflammation–related metaplasia, colonization by genetically altered adjacent mucosal cells, and continuation of risk behaviors like tobacco and alcohol.

Sep 21, 2026

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