Fungating tumour of the lower lid
This diabetic man presented with a three month history of a  large fungating tumour of the right lower lid. There was necrosis in the centre of the lesion. The tumour resembled an aggressive squamous cell carcinoma. However, histology of two incisional biopsies showed no evidence of malignant cells. The dermatologist thought this may be a giant keratoacanthoma. Due to the rapid growth of the lesion, an excisional biopsy was performed. The microscopic examination of the excised lesion revealed well-differentiated squamous cell carcinoma with involvement of the deep layer. Further examination was performed of the deep tissue which showed the tumour was completely excised. 
This case is a good example that incisional biopsy may not provide adequate sample for an accurate diagnosis.
Closure of the defect was achieved with rotational flap from the cheek and glabellar flap.
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