Das „explodierte Karbunkel“: Selbstbestimmte Therapieverweigerung bis in den Tod

A 75-year-old woman refused medical treatment of a squamous cell carcinoma of the facial skin for personal reasons, which led to a pronounced finding with exposure of brain structures. Cutaneous squamous cell carcinomas (PEK) account for almost 20% of all non-melanocytic skin tumors and are the second most frequent skin tumor after basal cell carcinoma. The incidence increases with age. Etiologically, actinic precancerous skin lesions caused by ultraviolet (UV) radiation as well as long-term damage caused by chemical noxae and also chronic inflammatory and degenerative skin changes play a role. The cause of death in the present case was a tumor toxic cardiovascular failure with pronounced tumor cachexia. It was impressive that even with destruction of the skull and brain parenchyma, death occurred in such an advanced stage of the disease and not earlier in time. The relatives could not be reproached for failing to provide help as an adult person in a state of clear thinking is allowed to refuse treatment.