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Another consideration was that patients with OCA have a 1000-fold risk of developing skin cancer and an increased risk of recurrence. Therefore, continual evaluation and screening are necessary. In this patient, we suspected double primary SCCs considering the location of the tumor, which theoretically spreads distantly; the size of the lesion at less than 2 cm; the depth of the lesion at less than 4 mm; and the well-differentiated cytology. Another consideration was that patients with OCA have a 1000-fold risk of developing ski