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A Successful Defect Closure After Total Excision of Seborrheic Keratoses with Atypical Clinical Presentation Using Island Pedicle Flap in an Elderly Patient

Authors Sutedja EK, Ahmed R, Sutedja E, Rowawi R, Suwarsa O, Gunawan H

Received 7 December 2020

Accepted for publication 10 February 2021

Published 3 March 2021 Volume 2021:14 Pages 157—161

DOI https://doi.org/10.2147/IMCRJ.S294839

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas


Eva Krishna Sutedja, Rafdi Ahmed, Endang Sutedja, Rasmia Rowawi, Oki Suwarsa, Hendra Gunawan

Department of Dermatology and Venereology, Faculty of Medicine, Padjadjaran University - Hasan Sadikin General Hospital, Bandung, West Java, 40161, Indonesia

Correspondence: Hendra Gunawan
Department of Dermatology and Venereology, Faculty of Medicine, Padjadjaran University - Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia
Tel\Fax +62 22 2032426 ext. 3449
Email [email protected]

Abstract: Seborrheic keratoses (SK) are benign skin tumor characterized by well-demarcated and skin-colored to pigmented papules, plaques, or nodules with stuck-on appearance. Typical SKs are normally treated for cosmetic reasons. However, total excision and histopathological examination have to be considered in SK with unusual properties. The island pedicle flap (IPF) is a method of flap for defect closure, especially on the cheek. It has the capability to maintain the vascularization, thus it is also suitable in the elderly. We report a case of an SK with atypical clinical presentation in a 69-year-old female, with a solitary enlarging, hyperpigmented, verrucous, and bleeding tumor. The dermoscopic examination did not show characteristic features of SK. Total excision was performed due to its clinical properties. The histopathological examination revealed hyperkeratosis, acanthosis, hyperplasia, and papillomatosis, along with intercellular pseudo-horn cyst which confirmed the diagnosis of SK. The patient underwent total excision of the skin lesion which left a primary defect. We performed IPF procedure to reconstruct the defect after total excision of the skin lesion. After a year of follow-up, no meaningful complication was detected. The final result of the procedure was satisfying due to its ability to restore the natural contour and texture match by utilizing cheek laxity, without interfering the nasolabial fold. In conclusion, IPF is an appropriate method for defect closure in an elderly patient after facial total tumor excision.

Keywords: atypical clinical manifestation, defect closure, facial tumor, island pedicle flap, seborrheic keratoses

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