Poorly Differentiated Squamous Cell Carcinoma With Jaw Bone Osteomyelitis and Skin Perforation: A Report of a Rare Clinical Case

Oral squamous cell carcinoma is a perpetual challenge for current clinicians and oral pathologists. In this case report, we present an unusual case of oral squamous cell carcinoma involving the left buccal mucosa with extensive bone exposure and skin perforation. It showed features of ulceration, necrosis, and maggot infestation. On histological examination, the malignant epithelial cells in the dense fibrous connective tissue stroma were keratinized, highly pleomorphic, had a high nucleo-cytoplasmic ratio, and were organized in sheets, cords, and nests. Decalcified tissue sections revealed the presence of necrotic bone. Immunohistochemistry indicated diffuse PanCK (cytokeratin) positivity confirming the epithelial origin of the malignant tumor cells. A final diagnosis of poorly differentiated squamous cell carcinoma (Bryne score 13/16) with chronic osteomyelitis and skin involvement was confirmed. Palliative care with supportive therapy was recommended. Hence, this case report emphasizes how critical it is to receive an early diagnosis and treatment to stop the disease progression, prevent the host's immune suppression, and improve the overall quality of life of the patient.