Pathirana T H, Bandaranayake V, Nellihela A P, Nikeshala S, Saranga T, Abegunasekara A, Gunathilake S, Asanthi N J
Surgical Oncology Unit, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka.
Histopathology Department, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka.
Cancer Rep (Hoboken). 2025 Jan;8(1):e70124. doi: 10.1002/cnr2.70124.
Basocellular carcinoma (BCC) is the most prevalent skin malignancy, often localizing to the UV-exposed skin of the face. While most BCC is relatively indolent, aggressive subtypes, including infiltrative BCC, pose the treatment challenges of ensuring functional and aesthetic preservation with a high risk of recurrence.
A 78-year-old female patient complained of recurrent left chin BCC of infiltrative subtype, which was first treated in 2013 by wide local excision and adjuvant radiotherapy. Recurrent carcinoma was reported in 2017, 2021, and most recently in 2023. The most recent recurrence presented with scar contracture, facial asymmetry, and drooping of the lip. Surgical resection involved extensive excision of the lower lip and chin, exposing the mandible. Reconstruction was achieved with the help of bilaterally designed Karapandzic flaps for the lip and a bilobed rotational flap for the chin defect. Although no chemotherapy and immunotherapy were given, the functional and aesthetic result were satisfactory. The procedure was executed while preserving the pertinent neurovascular structures, maintaining oral competence, and restoring the lower face. The Karapandzic flap was helpful in maintaining the lip function, whereas the chin was reconstructed using the bilobed rotational flap. Post-operative histology confirmed the diagnosis of BCC with squamous differentiation, which had clear margins. The patient did well and the cosmetic and functional outcome was satisfactory without any disease at 18 months after surgery.
This case sheds light on the difficulties encountered in treating recurrent facial BCC in developing countries. In the absence of systemic therapies, advanced surgical techniques and intensive follow-up resulted in a long disease-free period with good functional and aesthetic outcomes, thanks to the successful use of innovative reconstruction even in a low-resource setting.
基底细胞癌（BCC）是最常见的皮肤恶性肿瘤，常发生于面部暴露于紫外线的皮肤。虽然大多数基底细胞癌生长相对缓慢，但侵袭性亚型，包括浸润性基底细胞癌，在确保功能和美观的同时存在高复发风险，给治疗带来挑战。
一名78岁女性患者，主诉左下巴浸润性基底细胞癌复发。该患者于2013年首次接受广泛局部切除及辅助放疗。2017年、2021年及最近在2023年均报告有复发。最近一次复发表现为瘢痕挛缩、面部不对称和嘴唇下垂。手术切除包括广泛切除下唇和下巴，暴露下颌骨。借助双侧设计的Karapandzic皮瓣修复唇部，用双叶旋转皮瓣修复下巴缺损。尽管未进行化疗和免疫治疗，但功能和美观效果令人满意。手术过程中保留了相关神经血管结构，维持了口腔功能，恢复了下面部外观。Karapandzic皮瓣有助于维持唇部功能，而下巴则用双叶旋转皮瓣进行重建。术后组织学检查确诊为伴有鳞状分化的基底细胞癌，切缘清晰。患者恢复良好，术后18个月时美容和功能效果满意，无任何疾病复发。
本病例揭示了发展中国家在治疗复发性面部基底细胞癌时遇到的困难。在缺乏全身治疗的情况下，先进的手术技术和密切随访带来了较长的无病生存期以及良好的功能和美观效果，这得益于即使在资源有限的情况下成功运用了创新的重建方法。
