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患者男,62岁。枕部反复溃烂结痂4年。2年前诊断为鳞状细胞癌,行肿瘤扩大切除,右大腿中厚皮片游离移植术。术后7个月,原皮损处上缘再次出现糜烂结痂,溃烂面积逐渐扩大,疼痛明显。系统检查无明显异常,皮肤科情况:枕部一约5.5cm×2.5cm大小的溃疡,至深筋膜层深面,表面凹凸不平,部分区域可见脓性分泌物。实验室检查:WBC:10.3×109/L,NEU:7.10×109/L。头部MRI检查:颅骨及颅内未见确切异常,左侧枕部局部头皮软组织形态失常伴缺损。诊断:枕部鳞癌术后复发。前期治疗予以5-氨基酮戊酸光动力疗法(ALA-PDT),后期行Mohs显微描记手术,创面游离皮片移植。术后恢复良好,随访8个月未见肿瘤复发迹象。
Male patient, 62 years old. Occipital repeated ulceration scab 4 years. 2 years ago, the diagnosis of squamous cell carcinoma, line tumor expansion and excision, the right thigh thick skin graft. At 7 months after operation, the upper edge of the original lesion appeared erosion and scab again, the area of ulceration gradually enlarged and the pain was obvious. System examination no obvious abnormalities, Dermatology: occipital a size of about 5.5cm × 2.5cm ulcer, deep fascia deep, uneven surface, purulent secretions in some areas can be seen. Laboratory tests: WBC: 10.3 × 109 / L, NEU: 7.10 × 109 / L. Head MRI examination: No exact abnormalities were found in the skull and the cranium, and the scalp and soft tissue disorder in the left occipital region with defects. Diagnosis: occipital squamous cell carcinoma recurrence. Pre-treatment to be 5-aminolevulinic acid photodynamic therapy (ALA-PDT), Mohs microscopic postoperative surgery, wound free skin graft. Postoperative recovery was good, no signs of tumor recurrence 8 months follow-up.