Bilateral neglected facial invasive squamous cell carcinoma in an 89-year-old man, complete excision and primary reconstruction by cervicofacial flap, case report and review of current reconstruction approaches.

Introduction and importance: Non-melanoma skin neoplasms generally account for more than 80 % of occur in people in their 7th decade of life or higher, and increasing prevalence has made them a global concern. Squamous cell carcinoma (SCC) is the first step of the group of neoplasms mentioned above. An appearance of typical cutaneous squamous cell carcinoma (CSCC) is a non-healing, usually progressively enlarging erythematous papule, plaque, or ulcer. For cosmetic reasons, the surgeon should excise such lesions and then schedule second or third operations for flap-mediated reconstructions.

Case presentation: After reporting a novel case of bilateral neglected facial invasive SCC affecting the parotid region in an 89-year-old man whose treatment with a semi-therapeutic palliative approach, we have conducted a review of facial CSCC from the aspects of epidemiology, staging, and therapeutic management.

Clinical discussion: Despite mucosal SCC, cutaneous ones rarely metastasized, varying from 0.5 to 10 %. Subdividing primary cutaneous SCC into low and high-risk types has been of interest over the last decade since they behave differently regarding regional metastasis, resulting in prognosis differences. Most cutaneous SCC includes previously untreated small (less than 2 cm), thin (less than 2 mm), and well-differentiated cases.

Conclusions: The surgeons should weigh against the outcome of their approach. For instance, in the case of older people and the risk of multiple general anesthesia, a palliative approach can be considered.