Squamous cell carcinoma of the face

A 56-year-old male with a past medical history of active tobacco use and remote intravenous heroin use presents to the ED complaining of a 2-month history of a rapidly enlarging mass on his right cheek. He states the lesion began as a “small pimple” and rapidly expanded. Exam reveals a 10 cm by 10 cm exophytic and indurated mass protruding from the right face, extending from the preauricular area and zygoma to his proximal neck with a necrotic and purulent central region. CT imaging shows a necrotic infiltrative malignant mass of the right cheek with extensive right neck neovascularity and adenopathy at all cervical levels.

Biopsies revealed HPV-negative, poorly differentiated squamous cell carcinoma of the face. A PET scan demonstrated significant metastases to the spine, liver, and lungs. Three weeks later, the patient underwent resection of the facial mass with modified radical neck dissection and pectoralis flap placement. Three months later, he was transitioned to hospice care and died under unclear circumstances. (Via emra.org)