A Case Report on Facial Cutaneous Squamous Cell Carcinoma in Two Siblings: Challenges in Oncologic Resection and Local Flap Reconstruction
Benyoussef Jihane *
Department of Plastic, Reconstructive and Aesthetic Surgery, National Burn Center, Ibn Rochd University Hospital, Casablanca, Morocco.
Fikry Amine
Department of Plastic, Reconstructive and Aesthetic Surgery, National Burn Center, Ibn Rochd University Hospital, Casablanca, Morocco.
EL Moustakim Chaimaa
Department of Plastic, Reconstructive and Aesthetic Surgery, National Burn Center, Ibn Rochd University Hospital, Casablanca, Morocco.
Karti Sara
Department of Plastic, Reconstructive and Aesthetic Surgery, National Burn Center, Ibn Rochd University Hospital, Casablanca, Morocco.
El Harti Amine
Department of Plastic, Reconstructive and Aesthetic Surgery, National Burn Center, Ibn Rochd University Hospital, Casablanca, Morocco.
Diouri Mounia
Department of Plastic, Reconstructive and Aesthetic Surgery, National Burn Center, Ibn Rochd University Hospital, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Cutaneous squamous cell carcinoma (cSCC) is a common malignant skin tumour associated with cumulative ultraviolet exposure and constitutional susceptibility. A familial presentation may reflect a shared genetic background, similar environmental exposure, or predisposition syndromes. This case report describes two brothers with facial cSCC and highlights the oncological and reconstructive challenges associated with peri-orificial facial lesions.
Case presentation: Both patients had phototype II skin, chronic tobacco use, and ulcerative-exophytic facial lesions that evolved over one year from pre-existing actinic keratoses. The first brother presented with a pretragal lesion, and the second presented with a supraorbital lesion with frontalis muscle invasion.
Management and outcomes: Both lesions underwent en bloc excision with 1 cm safety margins. In the second case, intraoperative evidence of muscle invasion required submuscular pre-periosteal dissection, and subsequent histology showed a narrow 1 mm deep margin, prompting additional excision of the frontal periosteum. Reconstruction was delayed until clear margins were confirmed. Histology showed well-differentiated, ulcero-infiltrating cSCCs. The pretragal defect was reconstructed with a retroauricular transposition flap, preserving auricular contour. The supraorbital defect was reconstructed with an LLL (Dufourmentel) transposition flap from the non-hair-bearing scalp, allowing tension-free closure along the orbital rim.
Conclusion: These sibling cases illustrate the combined relevance of familial susceptibility, actinic field cancerisation, margin-oriented surgery, and flap selection. Long-term surveillance and screening of first-degree relatives remain important components of management.
Keywords: Cutaneous squamous cell carcinoma, familial susceptibility, actinic keratosis, field cancerisation, phototype II, oncological resection, deep-margin control, Dufourmentel flap, facial reconstruction.