Eur Arch Otorhinolaryngol (2011) 268:147–150 DOI 10.1007/s00405-010-1410-0 123 CASE REPORT Second primary squamous cell carcinoma arising in the skin of a pectoralis major myocutaneous Xap 12 years after Xoor of mouth reconstruction Ambrose Chung-Wai Ho · Patricia Yuen-Shan Fan · Tony Wei-Hung Shek · David Ho · William Ignace Wei Received: 18 July 2010 / Accepted: 11 October 2010 / Published online: 26 October 2010  Springer-Verlag 2010 Abstract Second primary squamous cell carcinoma (SCC) in the skin of a Xap used for reconstruction of Xoor of mouth is rare. A case of SCC arising in the pectoralis major myocutaneous Xap that was used to reconstruct the Xoor of mouth 12 years after subtotal glossectomy and resection of the Xoor of mouth is reported. The tumour is a second primary SCC arises in the skin of a myocutaneous Xap without any obvious risk factors. Review of the litera- ture reveals four previous similar reports and the Wndings are summarized. In summary, squamous epithelium of the skin Xap after prolonged exposure to non-physiological stimuli may lead to metaplasia and possible carcinoma formation. Long-term follow up and awareness of this complication are needed for head and neck cancer patients after resection and reconstruction. Keywords Squamous cell carcinoma · Second primary tumour · Oral cavity cancer · Pectoralis major Xap · Free Xap Introduction Ever since Bakamjian [1] reported the use of deltopectoral Xap in reconstructing the pharynx, various types of Xaps have been developed for the reconstruction of diVerent head and neck defects after surgical resection [2, 3]. The complications of diVerent regional and free Xaps have been reported extensively [4–6]. However, second primary tumours developing within a Xap are rare and only few cases have been described in the literature thus far. In this paper, we report a case of second primary squamous cell carcinoma (SCC) arising in the skin of a pectoralis major myocutaneous Xap 12 years after Xoor of mouth reconstruction. Case report A 53-year-old man presented with a non-healing tongue ulcer over the right side for 2 months in August 1994. He was a heavy cigarette smoker and was a social alcoholic drinker for more than 20 years. On physical examination, the ulcer measured 3 £ 2 cm with underlying indurations measuring 4 £ 3 cm at the lateral border of right tongue with mild ankyloglossia. The lesion did not cross the mid- line but was close to the Xoor of mouth. On examining the neck, there was a 2 £ 2 cm Wrm lymph node at level II over the right side. With a biopsy of the ulcer showed an inva- sive SCC and the Wne needle aspiration cytology of the lymph node showed a metastatic SCC, clinical staging of T2N1 was conWrmed. He underwent a subtotal glossectomy with resection of the right Xoor of mouth, right radical neck dissection and left side selective neck dissection (level I–III). 1.5 cm resection margins were taken around the tumour and intra-operative frozen section margins were all free of tumour. The defect was reconstructed primarily with the pectoralis major myocutaneous Xap (PM Xap) from the right chest. Final histology showed one metastatic lymph node with extra-capsular spread on the right radical neck dissection specimen and no metastatic lymph node on the left selective neck dissection specimen. All the resection A. C.-W. Ho (&) · D. Ho · W. I. Wei Division of Otorhinolaryngology, Head & Neck Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China e-mail: ambroseho@hku.hk P. Y.-S. Fan · T. W.-H. Shek Department of Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China