A Rare Neglected Pilomatrix Carcinoma on the Forehead: A Cas
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An 80-year-old gentleman presented to the accident and emergency department with a long history of a neglected mass on his forehead and a subsequent bifrontal sinus abscess culminating in marked cognitive impairment. His Glasgow Coma Scale was 8 and was clinically aphasic and had marked difficulty mobilising. An urgent CT head was ordered which showed an aggressive lesion in the forehead area eroding at the frontal bone and invading the cerebral cortex. The lesion measured 48 × 73 × 51 mm. At a later date, an MRI with contrast was conducted with both special investigations confirming an aggressive tumor invading the frontal sinus, frontal bone, cribriform plate, and extending intracranially.

Clinically and dermoscopically, the lesion appeared to resemble a basal cell carcinoma. Prior to surgery, the patient had a wedge biopsy which revealed a basal cell carcinoma with hair matrix differentiation (resembling a pilomatrixoma carcinoma). Following the multi-disciplinary team meeting, the patient was taken to theatres whereby en block excision of the bilateral frontal abscess was undertaken by the neurosurgeons. Sections of the frontal bone were also removed alongside the external components of the meninges-primarily the dura matter. The surgical site was closed with a craniofacial rotational flap and a split skin thickness graft harvested from the left thigh. There were no complications in recovery or the days following the surgery on the ward.

There was a large bony defect created secondary to the partial craniectomy which was planned for a secondary reconstruction following the adjuvant localized radiotherapy-this never materialized as the patient was content with the outcome and the deformity did not affect his quality of life. Staging of the cancer was completed via a combination of an ultrasound of the neck and computed tomography of the chest and abdomen which was negative for metastatic disease. In terms of toxicities, the patient suffered from grade 1 fatigue, hyperlacrimation with no evidence of conjunctivitis, and brisk erythema grade 2a radiation oncology/ toxicity grading alongside dysgeusia. These complications gradually settled over 6 months 3 years post-surgery, the latest MRI Head with contrast revealed no evidence of local or regional recurrence and thus no need for any further surgical intervention.

Source: https://www.longdom.org/open-access/a-rare-neglected-pilomatrix-carcinoma-on-the-forehead-a-case-report.pdf