A 58-year-old smoker and alcoholic man, with a history of excessive sun exposure, presented to the emergency department with a chief complaint of painful swelling of the left facial region. His facial swelling had started on the 06th day prior to admission, accompanied by an erythema around the cheek, which was painful. The erythema eventually spread to the entire left side of his face and involved the mucous membranes in the oral cavity, accompanied by a high fever of 40°C with a worsening of his general condition, and visual acuity of the right eye was diminished. Furthermore, he reports the occurrence of a painless plaque in his right nasal wing fold 02 years ago; with a history of handling and squeezing.

On local examination, the right side of face was diffusely swollen, erythematous, and indurated. There was a giant ulcerative growth arising from left lateral nasal wall of size approximately 10cm*6cm*5cm, encroaching whole, left upper lip, left cheek and left lower eyelid. Its surface was irregular and contained patches of necrotic tissue at places (Figure 1-2). Foul smelling seropurulent discharge was also present.

The patient was hospitalized for cellulitis and treated with intravenous antibiotics according to sensitivities (amoxicillin–clavulanic acid + fluoroquinolones + metronidazole), which produced only partial improvement after 3 weeks. A cranio-orbital Computerized tomography scan was performed that showed diffuse inflammation and a tumoral process involving the soft tissues of the face extending into the facial sinuses and eyelids on both sides. Signs of bone destruction particulary involving the lower wall of the left orbit and extension into the left extraconal fat, were observed. Therefore, an underlying tumoral skin disease was suspected and punch biopsy was taken after a surgical drainage and sent for histopathological examination, that conclude the diagnosis of well differentiated SCC, the extension assessment carried out did not reveal any notable anomaly. The therapeutic decision taken by the ENT (Ear, Nose and Throat) oncology committee consisted in opting for radiotherapy.