Labio-Jugal Squamous Cell Carcinoma on HIV Site: Surgical Excision and Reconstruction with a Musculocutaneous Flap of the Pectoralis Major: A Case Report

摘要

Introduction: Malignant skin tumors are very frequent lesions, induced by sustained sun exposure. Cutaneous squamous cell carcinoma is a dangerous cancer of the skin. It’s more frequent in white people than black people. Squamous cell carcinomas sometimes pose a real problem of local reconstruction after their removal. Reconstructions may involve the production of regional pedunculated flaps to repair the loss of substance. We report the case of a labio-jugal squamous cell carcinoma in an HIV-positive patient. The excision of the tumor required repair by a musculocutaneous flap of the pectoralis major. The aim of this paper is to show the dangerousness of that cancer, the particularity of its location around the mouth. We also want to call for a reflection about the recurrence of that disease on HIV infection ground, despite correct resection. Clinical Case: This was a 47-year-old HIV-positive patient on antiretroviral therapy (ARVs), treated 23 years ago for pulmonary tuberculosis. He presented with an ulcerated lower lip wound extending to the right labial commissure, right cheek, and the right lateral third of the upper lip. This lesion had progressed for about 6 months without a tendency to spontaneous healing. There was no palpable lymphadenopathy, especially in the cervicofacial region. The biopsy of the lower labial lesion concluded that it was a differentiated, mature, infiltrating squamous cell carcinoma. The craniofacial CT scan did not note any regional tumor invasion. We indicated tumor excision, functional lymph node dissection, and reconstruction by a flap of the pectoralis major muscle. The operative procedure was performed under general anesthesia. The edge cuts after carcinoma removal were healthy. Three months later, the patient is seen again with a local right submandibular recurrence. Radiotherapy was offered to him. Discussion: Squamous cell carcinomas are frequent in sub-Saharan Africa with preferential localization to oropharynx and oral cavity. More and more viral infections such as HIV, HBV and HCV are implicated in the occurrence of squamous cell carcinomas of the ENT and neck and facial sphere. HIV appears to be a contributing factor in young populations. Multidisciplinary management with anti-infective treatment coupled with new therapies could reduce the risk of recurrence and metastases.