This is a case of a 79 year old man who presented to the hospital with a large fungating right facial mass. He reports first noticing a small growth at the right eyebrow over a year ago. Over time, he had become increasingly self conscious of the mass and was isolating himself at home, refusing to go out or seek medical attention. On MRI, the mass extended deep into the right orbit with marked destruction of the right globe, the medial orbital wall, ethmoid, frontal and maxillary sinuses. Biopsy demonstrated invasive squamous cell carcinoma. . The patient underwent extensive surgery including wide resection of right facial squamous cell carcinoma, right partial maxillectomy with orbital exenteration, right partial rhinectomy and modified right neck dissection. He required temporary tracheostomy and gastrostomy tube immediately after surgery. Although very locally invasive, he did not have nodal or distant metastases. For his stage IV T4N0M0 disease, he completed a course of radiation. Although he tolerated multiple surgery and radiation treatments, he continued to have ongoing depression. He lacks social support and continues to have difficulty coping with his chronic illness. . Cutaneous squamous cell carcinomas (SCCs) are common lesions usually cured with local therapy in over 90 percent of cases. Compared to basal cell carcinomas, cutaneous SCCs have a higher potential for local recurrence and regional or distant metastases. In determining how to manage cutaneous SCC, the risk of local regional recurrence and regional or distant metastasis is the most important factor. Credit: Annie K. Hung MD, Hanley Ma MD at: Journal of General Internal Medicine.
"The Last of us" style 😬