A Case Report on Facial Cutaneous Squamous Cell Carcinoma in Two Siblings: Challenges in Oncologic Resection and Local Flap Reconstruction

Abstract

Background: Cutaneous squamous cell carcinoma (cSCC) is a common malignant skin tumour associated with cumulative ultraviolet exposure and constitutional susceptibility. A familial presentation may reflect a shared genetic background, similar environmental exposure, or predisposition syndromes. This case report describes two brothers with facial cSCC and highlights the oncological and reconstructive challenges associated with peri-orificial facial lesions. Case presentation: Both patients had phototype II skin, chronic tobacco use, and ulcerative-exophytic facial lesions that evolved over one year from pre-existing actinic keratoses. The first brother presented with a pretragal lesion, and the second presented with a supraorbital lesion with frontalis muscle invasion. Management and outcomes: Both lesions underwent en bloc excision with 1 cm safety margins. In the second case, intraoperative evidence of muscle invasion required submuscular pre-periosteal dissection, and subsequent histology showed a narrow 1 mm deep margin, prompting additional excision of the frontal periosteum. Reconstruction was delayed until clear margins were confirmed. Histology showed well-differentiated, ulcero-infiltrating cSCCs. The pretragal defect was reconstructed with a retroauricular transposition flap, preserving auricular contour. The supraorbital defect was reconstructed with an LLL (Dufourmentel) transposition flap from the non-hair-bearing scalp, allowing tension-free closure along the orbital rim. Conclusion: These sibling cases illustrate the combined relevance of familial susceptibility, actinic field cancerisation, margin-oriented surgery, and flap selection. Long-term surveillance and screening of first-degree relatives remain important components of management.