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Mohs Case - Squamous Cell Carcinoma

An 89-year-old male patient, presented to our office for the evaluation of a rapidly growing lesion on his left temple area.  A squamous cell carcinoma had been removed from the same area one month prior.  A biopsy of the lesion demonstrated a very aggressive moderately to poorly differentiated squamous cell carcinoma (Figure 1).  This type of skin cancer can grow rapidly and has potential for metastasis. 

Due to the aggressive nature of the lesion, Mohs surgery was performed.  After 3 stages of surgery the final defect can be seen below (Figure 2).

Closure options for this defect included a split thickness skin graft, and local tissue flaps.  Options were limited due to the large size of the defect.  The patient stated that he did not want a graft.  Together with the patient and his family, we agreed upon an inferiorly based rotation flap from the left cheek.  The final closure can be seen below (Figure 3).

Sutures were removed after one week, and at 4 weeks, excellent early surgical results were noted (Figure 4).  Normal anatomy was maintained, there was no alteration of the position of the corner of the eye or the position of the ear, and the hairline was re-created correctly.  The patient lost no motor function of the muscles of his face and was able to make a complete recovery.  He and his family were very happy with the results.

For a more in depth look at squamous cell carcinomas and why they need to be treated, check out our previous blog: Squamous Cell Carcinoma - When You Should Worry

Dr. David Roy Lead Pine Belt Dermatology Physician

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