Background:
Surgery has been considered the first choice of treatment in planocellular carcinoma. However, adjuvant radiotherapy is often required in R1 resection or in lymph node positivity. In order to reduce symptoms inoperable cases are also treated with ionizing radiation, although with palliative purposes.

Material and Methods:
A 87 year old diabetic, obese female patient was admitted to our department with a T4N1M0 stage planocellular carcinoma in the right retroauricular region for palliative irradiation to reduce ulceration. The tumor was 70x40 mm in diameter with purulent exulceration and inflammatory margins. Conventional 3D conformal radiotherapy was planned to deliver. Daily wound care and necrectomy were also performed with antibiotic prophylaxis for 10 days.

Result:
The patient had no fever or septic condition. Diabetes was controlled and was stable during treatment period. At 20 Gy dose a significant decrease in symptoms was observed with further graduate improvement during radiotherapy. External beam radiation was terminated at 54 Gy because of painful radiodermatitis in the ipsilateral neck region. At 3 month control a 0.5 cm lesion was still present, which completely healed by 6 month control with some residual scar tissue. Due to patient age and severe comorbidities surgery remained henceforward contraindicated.

Conclusion:
Palliative irradiation with daily surgical wound care has been considered one of the choices of treatment modalities in advanced cutaneous cancers. Our case demonstrates that palliative irradiation even in purulent condition is safe and may improve the quality of life of patients providing tolerable comfort for elderly patients and their family.