The Persistent Wound: A Complex Case of Recurrent Cutaneous Squamous Cell Carcinoma Following Mohs Surgery and its Management with Placental Allografts

Abstract

Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer in the United States, with over 1 million new cases each year. cSCC is categorized as low-risk or high-risk based on features including tumor size, depth, differentiation, and perineural invasion. High-risk cSCC has increased recurrence and poor prognosis, necessitating precise treatment. While Mohs micrographic surgery (MMS) offers higher cure rates for cSCC compared to conventional excision (CE), recurrence and challenges with defect healing remain. Emerging cellular and tissue-based products (CTPs), including placental allografts, provide innovative solutions for MSS defects and chronic wound healing.

Clinical Case: This paper explores the rare case of an 86-year-old woman with significant comorbidities (diabetes, obesity, and lymphedema) who presented to the clinic with chronic nonhealing pretibial ulcers harboring both invasive and in situ cSCC. Following MMS, the patient underwent treatment with EpiEffect and EpiFix placental allografts, which facilitated remarkable wound healing. Despite initial success, recurrence occurred after 12 months, necessitating a second Mohs procedure and subsequent application of CTPs, which again achieved complete wound closure.

Conclusion: This case highlights the challenges of managing recurrent cSCC in a high-risk patient with chronic wounds. It emphasizes the diagnostic complexity of malignancy in nonhealing ulcers, recurrence after Mohs surgery, and the innovative role of placental allografts in achieving rapid wound healing. By integrating oncologic and reconstructive approaches, this report underscores the importance of sustained vigilance in monitoring treated sites and provides valuable insights into optimizing care for complex, recurrent cSCC lesions.