Journal of Case Reports in Medical Science

Cutaneous squamous cell carcinoma (cSCC) is a common non-melanoma skin cancer that usually develops in chronically sun-exposed areas. Giant cSCC of the lower abdominal wall is rare and presents distinct oncological and reconstructive challenges, particularly when high-risk pathological features are present. This case report describes a 67-year-old man with a progressively enlarging ulcerated suprapubic mass measuring approximately 6.5×6 cm. Preoperative contrast-enhanced abdominopelvic computed tomography and inguinal ultrasonography showed no muscular or fascial invasion, regional lymph node involvement, or distant metastasis. The patient underwent wide local excision with oncological margins, resulting in a 14 × 9 cm soft tissue defect with preservation of the abdominal fascia. Reconstruction was performed using a modified abdominoplasty-like advancement and translation plasty, allowing primary closure without mesh reinforcement. Histopathological examination confirmed a moderately differentiated non-keratinising invasive cSCC with multiple vascular tumour emboli, consistent with lymphovascular invasion, and negative lateral and deep surgical margins. Adjuvant volumetric modulated arc therapy was delivered to the tumour bed at a total dose of 60 Gy in 30 fractions. At 18 months of follow-up, there was no evidence of local recurrence, regional nodal disease, distant metastasis, abdominal wall weakness, or incisional hernia, and the cosmetic outcome was satisfactory. This case supports careful multidisciplinary management of selected giant high-risk abdominal wall cSCC.