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Two years later, there was local recurrence, prompting a second laser resection and selective neck dissection. Further laser resection was performed 3 years later for another recurrence. Despite an initial encouraging response with local control, 4 years after the initial treatment, there was substantial progression with multiple cutaneous and subcutaneous metastases and further local recurrence soon after. Palliative radiotherapy to the cutaneous metastases provided partial benefit, transitioning to best supportive care. 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