Neglected Trichilemmal Carcinoma with Severe Opportunistic Cutaneous Wound Myiasis: A First Case Report and Implications for Elderly Rural Populations.

This report describes the first documented case of trichilemmal carcinoma (TLC) complicated by opportunistic cutaneous wound myiasis in an elderly rural female patient with a long-standing ulcerated scalp tumour and heavy maggot infestation. Histopathological examination confirmed the diagnosis of TLC. A two-stage management strategy was implemented for the patient: initial eradication of myiasis and control of bacterial superinfection, followed by wide local excision of the tumour with split-thickness skin grafting. The patient achieved a good therapeutic outcome with no tumour recurrence at the 5-month follow-up. This case emphasizes the importance of considering parasitic infestation in the differential diagnosis of neglected ulcerative cutaneous malignancies, especially among vulnerable rural elderly populations with limited healthcare access. It also underscores the necessity of a stepwise therapeutic approach prioritizing infection control prior to definitive surgery, and provides a practical management reference for complex infected cutaneous malignancies.