Second primary squamous cell carcinoma in an oral cavity free flap: A case report and review of the literature

Abstract

Recently, an increasing number of reports have described squamous cell carcinomas arising in free flaps used for maxillofacial reconstruction. Here, we report the case of a patient with second primary carcinoma arising in a free flap, and present a literature review of possible risk factors. A 59-year-old woman was referred to our department complaining of swelling in the lower gingiva in 2012. Her previous history included hypopharyngeal carcinoma for which she had undergone surgery and high-dose radiation therapy. We diagnosed her with osteoradionecrosis, and she underwent mandibular resection and simultaneous reconstruction with an anterolateral thigh flap. In 2016, the patient presented with an exophytic swelling with leucoderma on the free flap. We diagnosed the lesion as a second primary squamous cell carcinoma derived from the free flap used for the reconstruction. She underwent resection of the free flap under general anesthesia. Interestingly, we found mucosalization and hyphae-like Candida on the histopathological examination. Regarding factors of cancerization, it is reasonable to consider causes that lead to chronic inflammation, such as mucosalization (alteration in the environment), external stimuli in the oropharyngeal area, or candidasis. Keywords: Squamous cell carcinoma, Second primary carcinoma, Oral cavity, Free flap, Mucosalization, Candida