Division of Dermatology, Department of Internal Medicine, Dell Medical School at Austin, Austin, TX.
Dermatol Online J. 2020 Oct 15;26(10):13030/qt6vs4d5gz.
A 90-year-old man presented for evaluation of an incompletely excised squamous cell carcinoma above the right brow, with pathology demonstrating tumor extending to resection margins with perineural invasion. A cord of tumor was noted to extend past the orbital rim and towards the posterior orbit. Mohs excision versus coordinated resection and reconstruction with colleagues in the head and neck surgery and craniofacial plastic surgery departments were considered. Multidisciplinary consensus was to proceed with radical resection in the operating room followed by adjuvant radiation therapy. One year later, the patient presented to our Mohs unit with a 3cm eroded multinodular plaque. Following an in-depth discussion regarding the options of further surgery versus systemic treatment, the patient and his family opted to pursue consultation with a medical oncology consultant to discuss restaging and potential systemic therapy. A PET scan with concurrent CT revealed a hypermetabolic right temporal scalp mass without evidence of bony invasion or extension into the nodal basin. Immunotherapy with cemiplimab was started at a dose of 350mg IV every three weeks. After 7 cycles, the patient demonstrated complete clinical resolution with a repeat PET scan showing interval near resolution of abnormal metabolic activity.
一位 90 岁男性，因右眉上方部分切除的鳞状细胞癌进行评估，病理显示肿瘤侵犯至切缘，伴有神经周围侵犯。发现肿瘤条索延伸超过眶缘并向眶后延伸。考虑行Mohs 切除术，或与头颈部外科和颅面整形外科同事协作进行联合切除和重建。多学科共识是在手术室进行根治性切除，然后进行辅助放疗。一年后，患者因 3cm 侵蚀性多结节斑块来到我们的 Mohs 科室。在深入讨论了进一步手术与全身治疗的选择后，患者及其家属选择咨询肿瘤内科顾问，讨论分期和潜在的全身治疗。PET 扫描与 CT 同时进行，显示右颞头皮有一处高代谢肿块，无骨侵犯或向淋巴结盆延伸的证据。开始用 350mg 静脉注射 cemiplimab 进行免疫治疗，每三周一次。经过 7 个周期后，患者表现出完全的临床缓解，重复 PET 扫描显示异常代谢活性几乎完全消退。
