A reasonable explanation might be that neoplastic keratinocytes derived from the intraepithelial oral and pharyngeal mucosa spread into the skin paddle and produce new cancer, a theory proposed and described by Braakhuis et al.27 as the “patch-field carcinoma model.” However, in this hypothesis, the new neoplasm in the skin paddle would be an ordinary HNSCC; therefore, IHC staining should show a high rate of altered p53 type and negative p16 status. Here, TP53 is linked to neoplasm.