case_images: PMC11791106_01
case_images: Case 1: (A) Anterior and (B) superior views of a fungating squamous cell carcinoma
case_images: cureus-0017-00000078456-i01.jpg
case_images: PMC11791106_01_cureus-0017-00000078456-i01.jpg
case_images: FIG1
case_images: Physical examination revealed a foul-smelling and fungating mass measuring 26 x 22 cm, which covered most of the calvaria (Figure 1A). Vascularity was less prominent externally, with a few dilated veins over the forehead, although minor manipulation caused bleeding (Figure 1B). A two-stage radial forearm pedicled flap and split-thickness skin grafting were then performed (Figure 2C, Table 1).
case_images: Case 1: (A, B) Post-first-stage surgery showing excision and local flap coverage. (C) Post-second-stage surgery with a pedicled radial forearm flap. (D) Final postoperative result
case_images: cureus-0017-00000078456-i02.jpg
case_images: PMC11791106_01_cureus-0017-00000078456-i02.jpg
case_images: FIG2
case_images: In the first stage, margin-free en bloc resection was performed, followed by reconstruction using local flaps from the surrounding scalp (Figure 2A, 2B). A two-stage radial forearm pedicled flap and split-thickness skin grafting were then performed (Figure 2C, Table 1). He remained disease-free at the 12-month follow-up (Figure 2D).
case_images: PMC11791106_02
case_images: Case 2: (A) Anterior, (B) superior, (C) anterosuperior, and (D) posterior views of an undifferentiated pleomorphic sarcoma
case_images: cureus-0017-00000078456-i03.jpg
case_images: PMC11791106_02_cureus-0017-00000078456-i03.jpg
case_images: FIG3
case_images: Clinical examination revealed a foul-smelling, fungating mass measuring 22 x 20 cm (Figure 3A). The surface was partially ulcerated, with pustular discharge and necrosis (Figure 3B, 3C, 3D).
case_images: Case 2: (A, B) Postoperative lateral, (C) superior, and (D) posterior views of an undifferentiated pleomorphic sarcoma
case_images: cureus-0017-00000078456-i04.jpg
case_images: PMC11791106_02_cureus-0017-00000078456-i04.jpg
case_images: FIG4
case_images: Reconstruction was performed using a transposition flap from the parieto-occipital region of the scalp to cover the central defect, and split-thickness skin grafting was applied to the remaining areas (Figure 4A, 4B, 4C, 4D).