Medicine · 2025
Treatment of facial squamous cell carcinoma in a centenarian using a combination of surgery and photodynamic therapy: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Fu Xuefeng, Chen Kaili, Wang Meiyan, Zhang Min, Tu Qi, Zhu Lujian, Zhang Qiying
Аннотация
RATIONALE: Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer. Treating aggressive cSCC in very elderly patients, especially centenarians with significant health issues, poses a major challenge due to the risks of standard surgical excision under general anesthesia. This report presents a novel palliative approach that combines limited surgical resection, open-wound management, and photodynamic therapy (PDT) for facial cSCC in a centenarian, suggesting it as a safe and effective alternative when conventional treatments are unsuitable.
PATIENT CONCERNS: A 101-year-old female patient presented with a rapidly enlarging cutaneous mass on the left side of her face, characterized by erosive lesions and a malodorous scent. The patient reported no history of trauma or significant sun exposure.
DIAGNOSES: A computed tomography scan of the orbit identified a soft tissue shadow indicative of a mass located in the lateral aspect of the left orbit, whereas the remaining structures of both orbits appeared unremarkable, with intact bony walls. Clinical manifestations were suggestive of squamous cell carcinoma. Histopathological examination of the postoperative lesion tissue, utilizing hematoxylin-eosin staining, revealed a significant presence of squamous cells, along with scaly vortices, keratin pearls, and nuclear atypia, thereby confirming the diagnosis of squamous cell carcinoma.
INTERVENTIONS: The patient underwent a surgical resection in combination with PDT. Specifically, a straightforward surgical resection was executed with a 5-millimeter margin. The surgical incision was intentionally left open and not sutured. During the management of the open wound, PDT was administered.
OUTCOMES: The patient elected to undergo a surgical resection and a single PDT session, after which the wound gradually healed from the edges, drying without infection. Over 2 months, the wound healed by secondary intention, leaving a flat, stable scar. The patient was very satisfied with the cosmetic result and odor resolution. At a follow-up 7 months later, and until the patient's death from unrelated causes, there was no sign of local recurrence.
LESSONS: We suggest that surgery combined with open-wound and PDT could be a safe and effective treatment for squamous cell carcinoma in elderly patients and those with comorbidities who cannot undergo general anesthesia.
PATIENT CONCERNS: A 101-year-old female patient presented with a rapidly enlarging cutaneous mass on the left side of her face, characterized by erosive lesions and a malodorous scent. The patient reported no history of trauma or significant sun exposure.
DIAGNOSES: A computed tomography scan of the orbit identified a soft tissue shadow indicative of a mass located in the lateral aspect of the left orbit, whereas the remaining structures of both orbits appeared unremarkable, with intact bony walls. Clinical manifestations were suggestive of squamous cell carcinoma. Histopathological examination of the postoperative lesion tissue, utilizing hematoxylin-eosin staining, revealed a significant presence of squamous cells, along with scaly vortices, keratin pearls, and nuclear atypia, thereby confirming the diagnosis of squamous cell carcinoma.
INTERVENTIONS: The patient underwent a surgical resection in combination with PDT. Specifically, a straightforward surgical resection was executed with a 5-millimeter margin. The surgical incision was intentionally left open and not sutured. During the management of the open wound, PDT was administered.
OUTCOMES: The patient elected to undergo a surgical resection and a single PDT session, after which the wound gradually healed from the edges, drying without infection. Over 2 months, the wound healed by secondary intention, leaving a flat, stable scar. The patient was very satisfied with the cosmetic result and odor resolution. At a follow-up 7 months later, and until the patient's death from unrelated causes, there was no sign of local recurrence.
LESSONS: We suggest that surgery combined with open-wound and PDT could be a safe and effective treatment for squamous cell carcinoma in elderly patients and those with comorbidities who cannot undergo general anesthesia.