Keratinized tumor with aggressive evolution at the orofacial level

Squamous cell carcinoma accounts for 90% of the oral cavity carcinomas. Most commonly affects men over 50, smokers. We present the case of a 77-year-old patient diagnosed in our clinic with a rapidly evolutive, highly aggressive squamous cell carcinoma of the lower lip, with aesthetic and functional consequences. The onset of the tumor was at the lower lip and then rapidly spread to the entire surface of the chin. Dermatological examination revealed a suprainfected tumor, adherent to deep structures. The tumor exhibits numerous bumps at the surface, irregular edges, numerous ulcerations and purse bags. The tumor has invasive character, reaching the mandibular bone and was evolving for the last 3 months. The histopathological examinations showed squamous cells, intense nuclear tachycromasia, marked pleomorphism, hight nuclear and cytoplasmic ratio and frequent mitosis, thus being conclusive for the diagnosis of moderately differentiated squamous cel carcinoma. The bacteriological examination revealed bacterial infection with Proteus vulgaris and beta hemolytic Streptococcus. Computer tomography showed the partially necrotic tumor, located on the soft parts of the right mandibular region and submandibular adenopathies. There were no secondary disseminations. This case highlights the need for complete surgical excision of a rapidly evolving tumor with increased size, perineural and perivascular invasion, diagnosed at an early stage where appropriate treatment can be done.