title: Skin graft failure mimicking abscess masking local recurrence of vulvar cancer: a case report.
abstract: BACKGROUND
  Vulvar cancer is a rare gynecological malignancy and its local recurrence is even more uncommon. To date, no cases of recurrent vulvar cancer in split thickness graft area have been reported. We describe the first case of such recurrence.
  
  
  METHODS
  A 65-year-old G4P3013 presented with vulvar mass and itching. She had a 2 x 2-cm sized mass on clitoris and an ulcerated bulgy mass of 2 x 2.5 cm size was localized on left labia majora, of which a biopsy revealed invasive squamous cell carcinoma. She underwent a radical vulvectomy and bilateral inguinofemoral lymph node dissection via separate incisions. Her postoperative course was complicated by wound separation which was cored with a split thickness skin graft. Patient was advised to integrate her treatment with radiotherapy, but she refused it. Two months later, she consulted for a painful swelling in the operation field. The swelling resembled an abscess formation so it was drained and an outpatient antibiotic treatment was prescribed. At her second visit, it was noted that the above-mentioned lesion was persisting and so fine needle aspiration biopsy (FNAB) was performed and a local recurrence was retrieved beneath the graft failure. Then she underwent a wide local excision and adjuvant radiotherapy was initiated after patient's approval.
  
  
  CONCLUSIONS
  Careful surveillance is warranted as squamous cell carcinoma recurrence can even occur beneath the split thickness skin graft, especially in conjunction with graft failure. And for high risk patients adjuvant radiotherapy is critically important for avoiding recurrences.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Dr Zekai Tahir Burak Woman Health, Education, and Research Hospital, Ankara, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gungor
authors.forename: Adnan
authors.initials: A
authors.lastname: Simsek
authors.forename: Umit
authors.initials: U
authors.lastname: Bilge
authors.forename: Leyla
authors.initials: L
authors.lastname: Mollamahmutoglu
mesh_terms: D000038:Abscess; D000368:Aged; D044963:Biopsy, Fine-Needle; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D016038:Skin Transplantation; D014846:Vulvar Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*