54-year-old man presented with a second primary tongue squamous cell carcinoma,
which developed in the pectoralis major myocutaneous flap used for the
reconstruction of the right side of the tongue 20 years previously. The patient
had originally undergone concurrent chemoradiotherapy and subtotal glossectomy.
We believe that the carcinoma was likely caused by metaplastic transformation
of the flap skin due to its chronic exposure to stimuli not normally
experienced by the skin. The findings in this case suggest that patient
education and long-term follow-up are required following flap reconstruction in
cases of advanced oral cancer.