A 74-year-old male patient was admitted for rectal bleeding, constipation and weight loss.
In the initial examination, a cutaneous lesion of 2 months of evolution and 6 cm of diameter was observed in the right malar region. It was raised, circumferential, with central crater, around which there was a laterocervical consistency other purulent nodules.
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The patient developed a sigmoid colon adenocarcinoma.
Computerized Axial Tomography (CAT) showed a 6.5 cm mass occluding the right lower lobe in contact with the posterior wall of the left atrium, accompanied by upper lobe metastases with multiple right millidense nodules.
Because of this clinical picture, it was decided not to perform abdominal curative surgery, so that endoprostheses were placed at the level of the sigmoid colon.
As for the cutaneous lesion described and due to its rapid growth and evolution towards ulceration with exudate malolente, we opted for surgical removal.
In a programmed fashion and under general anesthesia, we removed the tumor including the superficial parotid lobe and the adenopathic mass of about 3 cm in diameter, right laterocervical.
The coverage of the created defect was performed using a 9 x 3 cm island submental flap. The donor area of the flap was closed directly.
The intervention was uneventful, with a total duration of 110 minutes.
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Anatomopathological examination of the resected surgical specimen of the right cheek described a metastasis of adenocarcinoma in 6 cutaneous nodules, the largest of them 6 cm in diameter, 1 mm from the deep edge of the lymph node, repeating it.
The study of cervical lymph nodes was positive for metastasis of adenocarcinoma in 1 out of 5 lymph nodes, which is completely annulled by the tumor location capsule and surrounding tissue.
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The immediate postoperative period was satisfactory without any incidence and good aesthetic result.
The patient died at home 36 days after hospital discharge due to the distant spread of his primary disease.
