86-year-old man presented in June 2017 with a 2 month history of squamous cell carcinoma of the left cheek. The lesion was partially treated with Mohs surgery on 6/12/2017. Due to the size of the defect and depth of extension into the ear and the parotid gland, Mohs surgery was stopped after 3 levels. Patient has a h/o multiple myeloma, diabetes, CAD with congestive heart failure, and venous stasis ulcers.
This is an aggressive high risk squamous cell carcinoma of the skin and subcutaneous tissues. The patient has clinical induration of the tumor with fixation to the underlying parotid tissue and deep fascia. Treatment for this patient requires wide local resection, parotidectomy with facial nerve dissection, and a large flap reconstruction. Most likely, the patient will have lymph node involvement at least in the parotid gland and would require radiation therapy post-operatively. The extent of radiation therapy could involve the face, the parotid gland, and likely the neck. Given the patient’s advanced age and significant medical condition, his prognosis is poor. He is also at risk of significant perioperative complications. An alternative consideration for this patient is treatment with radiation therapy alone for palliative reasons.