When I was a senior resident, a patient came into the Veterans Administration hospital with a huge fungating squamous cell tumor that had essentially replaced three-fourths of his nose. He was homeless, an alcohol abuser, malnourished and had unfortunately allowed this to grow over time. Resection resulted in significant cosmetic compromise, and reconstructive planning had to take into account the tumor, the defect, and the attendant socioeconomic and nutritional aspects pertaining to this patient.
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