title: Squamous cell carcinoma arising in a skin flap: case report and review on malignant transformations in skin grafts and microvascular cutaneous flaps.
abstract: OBJECTIVE
  Sufficient closure of intraoral defects can be challenging. Various methods of tissue transfer have been presented in the literature. From skin grafts to microvascular flaps, most techniques used for intraoral reconstruction use skin to line out the oral cavity to guarantee an epithelial surface. Native mucosa tolerates the moist environment of the oral cavity, whereas skin flaps do to just a certain extent. This may lead to chronic inflammation of the flap-skin. Under rare circumstances, these histologic changes can enhance the risk for malignant transformation of the skin graft.
  
  
  METHODS
  We present a case of a patient who derived a squamous cell carcinoma in the skin island of a jump flap raised from the abdominal wall 30 years earlier. The flap was used to close a very wide palatal cleft. The patient had no history of malignancy, smoking, drinking, or other risk factors.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first report on carcinoma in a skin flap in a patient without any history of intraoral malignancy. Although malignant transformations of skin grafts are very rare and usually appear years after the reconstruction, one should be aware that the moist environment can lead to chronic inflammation of the dermis of flap. This fact may increase the risk of malignant transformation in a skin graft.
authors.affiliation: Department of Cranio-maxillofacial and Oral Surgery, University of Zurich, Zurich, Switzerland. wolfgang.zemann@usz.ch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zemann
authors.forename: Christine
authors.initials: C
authors.lastname: Jacobsen
authors.forename: Michael
authors.initials: M
authors.lastname: Malek
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
authors.forename: Joachim A
authors.initials: JA
authors.lastname: Obwegeser
mesh_terms: D002180:Candidiasis, Oral / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002972:Cleft Palate / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009061:Mouth Mucosa / Q000601:surgery; D009062:Mouth Neoplasms / Q000473:pathology*; D019651:Plastic Surgery Procedures / Q000379:methods; D016038:Skin Transplantation / Q000473:pathology*; D013524:Surgical Flaps / Q000473:pathology*