Abstract

This case describes a 29 year old cigarette smoker with underlying Systemic Lupus Erythematosus (SLE) treated aggressively with cytotoxic immunosuppression (cyclophosphamide and mesna). Five years later and at approximately 12 weeks pregnant she is confirmed as having squamous cell carcinoma of the right lateral border of the tongue with early local invasion. Not wishing to consider termination of her pregnancy, she underwent surgical resection; which included tracheostomy, right functional/selective neck dissection, manibulotomy, partial glossectomy and oral reconstruction using left radial forearm flap with microvascular reconstruction. Good oral function (speech and swallowing) was restored within two weeks. Potential complications include thrombosis of the microvascular reconstruction secondary to the hypercoagulable state associated with SLE and pregnancy and the complications of surgery itself on the pregnancy, namely miscarriage. The pregnancy proceeded relatively uneventfully to 37 weeks gestation when proteinuric hypertension necessitated induction of labour. The patient remains well, however, some of the scars have healed with hypertrophic/keloid scar formation. There is currently no evidence of recurrence but surveillance is essential and continues.