A 72-year-old man is seen for an evaluation of a scaly lesion behind his right ear. A biopsy confirms the diagnosis of squamous cell carcinoma, and the lesion is excised with clear margins. Secondary intention allows the wound to heal. The patient returns to the office three weeks later with a 2.5-cm raised, soft, granular lesion at the excision site. The image below depicts a biopsy of a representative lesion: Which of the following is most likely responsible for this patient's postoperative changes?

Question

A 72-year-old man is seen for an evaluation of a scaly lesion behind his right ear. A biopsy confirms the diagnosis of squamous cell carcinoma, and the lesion is excised with clear margins. Secondary intention allows the wound to heal. The patient returns to the office three weeks later with a 2.5-cm raised, soft, granular lesion at the excision site. The image below depicts a biopsy of a representative lesion:  Which of the following is most likely responsible for this patient's postoperative changes?

Quizplus · Accepted Answer

Eductional Objective: Normal wound healing requires fibroblast and vascular proliferation (ie, granulation tissue) induced by vascular endothelial growth factor (VEGF). However, if this tissue proliferation becomes excessive (as in secondary intention wounds), the resulting hypergranulation tissue can impair wound reepithelization and remodeling.

A 72-Year-Old Man Is Seen for an Evaluation of a Scaly