Conger, Jordan R.; Grob, Seanna R.; Tao, JeremiahRead More
An 87-year-old woman presented with worsening right facial and periocular pain due to a large facial mass. She was diagnosed with squamous cell carcinoma 1.5 years before and received radiation therapy at an outside institution. Examination revealed a large 10 × 11 cm ulcerative facial lesion over the right temporal region extending to the lateral canthus with proptosis (Fig. A). Silver nitrate can be seen atop the lesion. Extraocular motility showed severe limitation in all directions. Imaging demonstrated tumor in the orbit, through the skull base, and down to the temporal lobe of the brain. Histopathologic analysis from previous biopsy demonstrated a well-differentiated invasive squamous cell carcinoma with keratoacanthomatous features. Given the extent of the lesion, poor overall physical condition, and advanced age, the patient opted for nonoperative care. In an attempt to palliate this invasive tumor, the patient received 8 infusions of pembrolizumab (Keytruda; anti-PD1, immunotherapy agent). Six months after, external examination showed significant regression of the lesion with cicatrization down to the temporal fossa with an exposed, escharred lateral zygomatic arch and lateral frontal bone (Fig. B).