BACKGROUND: Although syringoma is a common benign tumour of the sudoriferous gland, there is also an extremely rare malignant form known as syringoid eccrine carcinoma (SEC). SEC usually exhibits slow growth with deep invasion and a frequent tendency to relapse. The treatment of choice is radical wide resection, which poses a difficult reconstructive problem, especially when the tumour is located in the centre of the face. CASE PRESENTATION: In this case, a 70-year-old man was diagnosed with an SEC at the same location as a benign syringoma of the upper lip and nasal base that had undergone primary excision 7 years prior. Primary radical resection was performed with immediate Abbé flap reconstruction. Nevertheless, histology revealed positive margins, and 3 additional re-excisions were needed to achieve clear margins. Four months after the initial resection, the patient had undergone an innovative reconstruction technique including not only the Abbé flap but also a turbinate flap harvested with functional endonasal surgery and a three-stage forehead flap. CONCLUSION: To the best of our knowledge, this is the first case report of a suspect malignant transformation of a benign syringoma after 7 years. In addition, from oncoplastic and reconstructive points of view, the bilateral use of the turbinate flap for reconstructing the intranasal lining of the alar base is unusual, and the use of functional endonasal surgery in nasal reconstruction for reducing the risk of damaging the vascular supply of the flap is innovative.

Department of Clinical and Molecular Pathology University Hospital and Medical Faculty of Palacky University 1 P Pavlova 6 77900 Olomouc Czech Republic

Department of Oral and Maxillofacial Surgery University Hospital and Medical Faculty of Palacky University 1 P Pavlova 6 77900 Olomouc Czech Republic

Department of Plastic and Aesthetic Surgery St Anne's Faculty Hospital and Medical Faculty of Masaryk University Berkova 34 612 00 Brno Czech Republic

Department of Surgical Oncology Masaryk Memorial Cancer Institute and Medical Faculty of Masaryk University Zluty Kopec 7 656 53 Brno Czech Republic

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