Facial Skin Myiasis Associated With Advanced Skin Cancer: Failure of Early Detection

Abstract

A 58‐year‐old Caucasian man with Fitzpatrick skin type I presented to the emergency department with an ulcer at the periauricular area. Despite ulceration and chronic inflammatory changes of the border, there was no cellulitis, abscess formation, or gross infection. The center of the wound presented with more than two dozen small maggots (Figures 1 and Figures 2). After diagnosis at the emergency department, the patient was admitted for surgical treatment. One extensive area of the soft tissue was removed. The resection included soft tissue of the preauricular area down to the superficial musculoaponeurotic system, occipital areas in full thickness down to the mastoid bone, and amputation of the inferior one third of the ear (Figure 3). Due to the extension of the resection, multiple flaps were used for reconstruction. A combination of three fasciocutaneous flaps was used to close the defect and reconstruct the ear. The entire procedure was performed in a single operation. Multiple specimens were adequately identified and sent to pathology for histologic diagnosis and evaluation of the margins of resection. The pathology report confirmed a basal cell carcinoma with perineural invasion, no cartilage involvement, and presence of maggots. The postoperative time was unremarkable, and the flaps healed without complication. The patient was referred to oncology for follow‐up and possible radiation therapy due to the depth and advanced invasion of the soft tissue by the tumor. The patient responded very well to the treatment, and the reconstruction offered a good cosmetic and functional result (Figure 4). View of the ulcerated lesion with the presence of myiasis image Close view of the ulcerated lesion with multiple foreign bodies (larvae) image Local view after extensive resection. Note the partial amputation of the ear and a complete resection of the ulcerated tumor. image View of the facial area after reconstruction of the ear and face with posterior and anterior fasciocutaneous flaps image