Squamous Cell Carcinomas on Forehead - Mohs Case
Dr. David Roy • June 21, 2019
An 81 year-old male patient, presented to our office for treatment of two large squamous cell carcinomas of his forehead. He and his son stated that the lesions had been frozen several times over the last 6 months and that no improvement had been noted. Two stages of Mohs micrographic surgery were required to clear the top tumor and a single stage was required to clear the lower tumor. A significant portion of the muscle had to be removed due to deep involvement of the tumor. The cancer did not involve the bone. The final defect involved a significant portion of the patient’s forehead (Figure 1).
Several closure options were reviewed with the patient. The defect was too wide, and the patient’s tissue was too tight to bring the two sides together. Due to the exposed bone, a full thickness skin graft was not an option as it would likely not survive direct placement on bone. Bone provides no vascular supply to the graft. A modified Z-plasty was performed due to the shape of the two defects, the mobility of the tissue and the need to avoid excessive lift of the patient’s eyebrows (Figure 2).
The sutures were removed after one week of healing (Figure 3).
As noted in the photo, the eyebrows are level, both flaps have survived the surgery and excellent early results are achieved. The patient was extremely happy with the results and had no complications during the course of his healing.
Squamous Cell Carcinoma (SCC) is the second most common form of skin cancer. It’s usually found on areas of the body damaged by UV rays from the sun or tanning beds. Sun-exposed skin includes the head, neck, chest, upper back, ears, lips, arms, legs, and hands. While this cancer is considered slow growing, it can spread to the tissues, bones, and nearby lymph nodes, where it may become hard to treat. When caught early, it’s easy to treat. This is a skin cancer that we see a lot of in the Hattiesburg and Laurel, Mississippi area. Here is Mississippi, we love our outdoors which increases the risk of developing skin cancer. We also have a multitude of manufacturing and agriculture jobs in the area that increase the amount of time spent in the sun, which over time has cumulative increased risk of developing squamous cell carcinomas, basal cell carcinomas, merkel cell carcinomas, and melanoma.
When a ‘Rash’ Might Be Something More Serious At Pine Belt Dermatology & Skin Cancer Center, we recognize that rashes are common and frequently resolve quickly with minimal treatment. However, some rashes may signify underlying conditions that require prompt medical attention. Identifying when a rash is more than a minor irritation is key to protecting your health. Comprehending Common vs. Concerning Rashes Most everyday rashes result from irritants, allergies, heat, or minor infections and typically improve within a few days with over-the-counter treatments. However, if a rash lasts longer, worsens, or appears with other symptoms, it may signal a more serious issue. Identifying the difference between a routine rash and one that requires medical evaluation helps avoid complications and ensure appropriate care. Warning Signs to Watch For Certain features may indicate a rash requires clinical assessment, including: Rapidly spreading or worsening rash Severe pain, swelling, or blistering Signs of infection such as pus, warmth, or red streaks Fever or flu-like symptoms accompanying the rash A rash that does not improve after several days of treatment Dark, purple, or bruised-looking areas on the skin For example, a rash with fever may indicate a viral or bacterial infection, whereas painful blistering can suggest conditions such as shingles. In rare cases, rashes may signal autoimmune disorders or severe allergic reactions. Rashes That May Point to Underlying Conditions Some rashes may be linked to broader health concerns, including conditions that cause inflammation in the skin and other organs: Allergic reactions that may escalate into further severe responses Infections that spread beyond the skin if untreated Medication reactions that require immediate adjustment Persistent or unusual skin changes may be early signs of skin cancer or precancerous conditions, especially if they do not heal or continue to change over time. Why Early Evaluation Matters Delaying care for a worrisome rash may allow the underlying condition to progress. Early diagnosis improves treatment outcomes and helps prevent discomfort and complications. A dermatology specialist can assess the rash’s appearance, location, and progression, and may recommend diagnostic tests if needed. This approach assures treatment addresses the underlying cause, not just the visible symptoms. When to See a Dermatology Specialist If you are unsure about your rash, it is best to err on the side of caution. Consider seeking care if: The rash is persistent, painful, or unusual in appearance Over-the-counter treatments are not effective You experience additional symptoms such as fever or fatigue The rash interferes with your daily comfort or quality of life At Pine Belt Dermatology & Skin Cancer Center, our experienced providers supply comprehensive skin evaluations and customized treatment plans. We take time to understand your symptoms and deliver clear, effective solutions tailored to your needs. Protecting Your Skin and Your Health While many rashes are minor, some may be early warning signs of more serious health concerns. Monitoring skin changes and pursuing prompt medical advice can produce a notable effect. If you notice a rash that does not seem right, do not ignore it. Schedule a consultation with Pine Belt Dermatology & Skin Cancer Center for expert evaluation and peace of mind. Your skin is an important indicator of your overall health, and taking it seriously supports ongoing well-being.
At Pine Belt Dermatology & Skin Cancer Center, we know that healthy skin is affected by more than just external care—it’s related to your overall health...
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