Abstract
We report a case of terminal stage mandibular gingival cancer treated with Mohs’ paste for chemosurgery under ambulatory care. An 84-year-old woman with lower gingival squamous cell carcinoma （T2N2bM0） had refused surgery, so chemoradiotherapy （S-1: 80 mg/day for 42 days, total dose of radiation: 60 Gy/30 fr） was administered. Post-treatment evaluation indicated complete remission. However, 18 months later, local recurrence of the tumor was confirmed in the same region. Two years and nine months later, the tumor infiltrated into the right mandibular skin and formed a pedicle. Additionally, blood and exudate were generated from the surface. Chemosurgery using Mohs’ paste under ambulatory care was planned and implemented. We applied Mohs’ paste to the tumor and removed the fixed part of the tumor without anesthesia after 24 hours. A similar operation was repeated until the tumor was reduced. Bleeding and exudate were controlled, and gauze replacement was reduced to once daily. However, her general condition gradually worsened, and she died at her home 3 months later. Chemosurgery with Mohs’ paste is useful for palliative care during the terminal stage and it seems to be useful for ambulatory and home medical care.
