The pathology results from the July trip have arrived. One notable result is from a patient named Innocent. I met Innocent in February, 2011. He is a young male that had a huge mass growing from the right side of his face for years. He had been to several medical centers but the surgeons refused to operate-either the surgeons lacked the required skills or the patient lacked the required funds.

The tumor was quite spectacular. Each time Innocent removed the dressings covering the tumor, blood squirted from the bottom. As a result, Innocent was anemic as well as malnourished (since he had no money for food).

For this complicated case, I called in the A-Team-Dr. Mike Enyinnah (a general surgeon and past student of mine). We rapidly removed the tumor and controlled the bleeding. The wound did not start granulating until we bought Innocent 6 eggs per day for two weeks! Then we skin grafted the wound.

The pathology showed a dermatofibrosarcoma protuberans (DFSP)-fibrosarcomatous variant (FS). This tumor is a rare soft tissue sarcoma that is usually not malignant but tends to recur locally-especially if the surgical margins are close to the tumor. The FS variant is more malignant. Unfortunately for Innocent, the margins were very close (since we could not remove his head) and the pathology worrisome. 

In July he came back for a checkup and had a small nodule at the edge of the wound. We performed a biopsy and, unfortunately, it showed a recurrence of DFSP but without the FS variant.  As a result, he will need radiation therapy. Of course, radiation therapy is difficult in Nigeria. There are only 2-3 sites that do this treatment and it is costly. Innocent will have to travel to Zaria, in Northern Nigeria, which is over 500 miles from NCH. The trip on a bus will take 21 hours! Earthwide Surgical Foundation will pay for his treatment.