PMC5771727_01
A, Dotted outline of biopsy site and white, linear, lichenified plaque lateral to biopsy site. B, Two-centimeter ulcer with exposure of porous polyethylene implant. C, Continued expansion of the ulcer, which raised concern for infection, recurrent squamous cell carcinoma, acitretin complication, or an inflammatory dermatosis such as pyoderma gangrenosum or erosive pustular dermatosis. D, Patient after hardware removal, left orbital exenteration, and free flap reconstruction.
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Given concern for possible SCC recurrence with supratrochlear nerve involvement, a shave biopsy was obtained at the site of the patient's pain (Fig 1, A). He soon developed a 2-cm ulcer with clear exposure of the implant (Fig 1, B). Continued expansion of the ulcer while awaiting surgical resection raised concern for infection, recurrent SCC (assuming sampling error of the previous biopsy), poor wound healing secondary to prior usage of acitretin, and inflammatory dermatoses such as pyoderma gangrenosum or a variant of erosive pustular dermatosis (Fig 1, C). Treatment consisted of removal of hardware, left orbital exenteration, and free-flap reconstruction (Fig 1, D).