CASE REPORT A Case of Giant Squamous Cell Carcinoma Buttock Arising from Hidradenitis Suppurativa: an Unusual Presentation Prakash Chandra Kala 1 & R. K. Sahu 1 & Jeewan Ram Bishnoi 2 & Ashok Puranik 3 Received: 25 October 2018 /Accepted: 28 February 2019 # Association of Surgeons of India 2019 Abstract A 78-year-old male presented with a large ulceroproliferative growth on the left gluteal area. Histopathology suggestive of squamous cell carcinoma. The tumor arising from underlying hidradenitis suppurativa. In this patient, unlike typical furuncles, the lesions lack characteristic central rupture and drainage. There was no signs of metastasis. Tumor removed by wide excision and reconstruction done with VY advancement flap. Keywords Hidradenitis suppurativa . Squamous cell carcinoma . VYadvancement flap Introduction Hidradenitis suppurativa is clinically well defined [1] with recognized diagnostic criteria and established physical char- acteristics [2]. Untreated, the disease causes significant mor- bidity. Some patients may lack characteristic central rupture and drainage. Long-standing sinus tracts form palpable, rope like fibrotic subcutaneous scars. Particularly, severe or exten- sive sinus networks can extend into deeper tissue, including muscle, fascia, lymph nodes, and other structures, depending on anatomic location (urethra or rectum) [3]. Hidradenitis suppurativa may get malignant transformation under chronic irritation. Squamous cell carcinoma is the most common ma- lignancy arises from hidradenitis suppurativa. It is more com- mon in men and incidence increases with age and duration of hidradenitis suppurativa. The more the delay in diagnosis, the more advance the disease and the more the chances of metas- tasis [4]. Proper vigilance should be there with ulcerative le- sions. Active intervention required in ulcerative lesions espe- cially in gluteal area [5]. Case Report A 78-year-old male presented with soft and painless lump in left buttock for 40 years. Patient noticed gradual enlargement of swelling for the last 8 months. Initially, low grade dull aching pain was there but later on patient develop throbbing pain. Patient visited to the Department of Surgery AIIMS Jodhpur and initially diagnosed as abscess left buttocks. Incision and drainage were done. But wound does not heal for long time and later proliferative growth starts sprouting through wound. There is single ulcer of size 4 × 5 cm with surrounding induration (5 cm). Wedge biopsy suggestive of squamous cell carcinoma. Computed tomography pelvis showed irregular enhancing soft tissue density over the left gluteal region with few adjacent collection. Few sub centric enhancing left inguinal lymph nodes. R0 resection with wide margin was done. After excision, there was a large defect of 15 × 15 cm. Proper planning done to cover defect with V-Y advancement flap based on perforator of inferior gluteal artery. V-Y advancement done in superior direction (Fig. 1). Post- operative period was uneventful. Biopsy suggestive of mod- erately differentiating squamous cell carcinoma (Fig. 2). Margins and base are free of tumor. The follow-up flap well settled with normal gluteal fold. Discussion Hidradenitis suppurativa is a chronic inflammatory recur- ring skin condition that involves the follicular occlusion * Prakash Chandra Kala drpckala@gmail.com 1 Department of Plastic Surgery, AIIMS, Jodhpur, Rajasthan, India 2 Department of Onco Surgery, AIIMS, Jodhpur, India 3 Department of Surgery, AIIMS, Jodhpur, India Indian Journal of Surgery https://doi.org/10.1007/s12262-019-01879-3