Successful management of near-infrared photoimmunotherapy-induced skin injury using pedicled flap transfer

Near-infrared photoimmunotherapy (NIR-PIT) is a recently developed cancer treatment which employs the combination of an antibody-photoabsorbor conjugate and NIR light. Currently, NIR-PIT is approved only in Japan for the treatment of unresectable, locally recurrent head and neck squamous cell carcinoma, using the anti-epidermal growth factor receptor antibody cetuximab and the photoabsorber IR700. However, there is no consensus on the optimal timing and management of NIR-PIT-induced skin injuries from both functional and oncological perspectives. Here, we report the case of a 71-year-old male with locally advanced tongue squamous cell carcinoma who developed a large skin ulcer and necrosis around the anterior neck following NIR-PIT. To prevent local infection and promote wound healing, oral antibiotic treatment and debridement were performed at the outpatient clinic. After confirming the absence of tumor recurrence, the patient was successfully treated using a well-vascularized pedicled flap. This case highlights two key management considerations for NIR-PIT-induced skin injury: surgical indications and cancer treatment. Further studies are necessary to improve the management of severe skin complications following NIR-PIT.