title: Squamous cell carcinoma arising on a forearm free flap 21 years after hemiglossectomy.
abstract: OBJECTIVE
  Free and pedicled flap are methods of choice for reconstruction of post-surgical defects consequent to oral squamous cell carcinomas (SCCs), and missing intraoral mucosa is commonly reconstructed by the cutaneous component of the flap to guarantee an epithelial lining. Even if rare, cases of second tumors arising in the skin flap have been described. We present our experience reporting a clinical case.
  
  
  METHODS
  A squamous cell carcinoma arose on a forearm free flap 21 years after hemiglossectomy in a 72 years old woman. No smoking or alcohol habits were referred, and it was decided to perform surgical resection of the flap.
  
  
  RESULTS
  Resection in free margins of a moderate differentiated (G2) SCC staged as pT2 was achieved and reconstruction with anterolateral thigh free flap was performed.
  
  
  CONCLUSIONS
  Even if rare, secondary tumors arising in the skin flap in case of oral cavity defects reconstruction are described. It is important to recognize them early in order to perform surgical resection.
  
  
  CONCLUSIONS
  We think that it is fundamental to perform a prolonged follow-up of skin flap if a white patch or erythema raising clinical suspicion are present. Incisional biopsy has to be performed in order to identify those lesions potentially inclined to a malignant transformation, such as p53 expression and Ki67 index.
  
  
  BACKGROUND
  Free flap, Oral cancer, Squamous cell carcinoma.
authors.forename: Valentino
authors.initials: V
authors.lastname: Valentini
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassoni
authors.forename: Valentina
authors.initials: V
authors.lastname: Terenzi
authors.forename: Gianmarco
authors.initials: G
authors.lastname: Prucher
authors.forename: Oriana Rajabtork
authors.initials: OR
authors.lastname: Zadeh
authors.forename: Sandro
authors.initials: S
authors.lastname: Bosco
authors.forename: Evaristo
authors.initials: E
authors.lastname: Belli
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D005260:Female; D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps / Q000473:pathology*; D005927:Glossectomy / Q000379:methods; D006801:Humans; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome