Giant exophytic basal cell carcinoma treated with radiotherapy

Spontaneous Regression of Two Giant Basal Cell Carcinomas in a Single Patient after Incomplete Excision

Background

Spontaneous regression of small basal cell carcinoma has been reported. For giant basal cell carcinoma, however, no spontaneous regression has been described to date.

Case report

We present a patient with two independent giant basal cell carcinomas over the left clavicle and the lower back, measuring 7 × 12 cm and 18 × 20 cm, respectively. Both tumors were excised incompletely (R2) and the patient refused follow-up resections. After 52 and 16 months, respectively, no signs of recurrence were observed.

Conclusion

Incompletely excised giant basal cell carcinomas can regress spontaneously. A watch-and-wait approach after incomplete resection may be pragmatic to avoid mutilating follow-up resections in patients refusing further surgery.

Giant Basal Cell Carcinomas Arising on the Bilateral Forearms of a Patient: A Case Report and Review of Nonsurgical Treatment Options

Giant basal cell carcinomas (GBCCs) are large basal cell carcinomas (BCCs; <5 cm) with a greater propensity to invade and metastasize than standard BCCs. The presence of 2 GBCCs in a single individual is rare. We present the case of a 71-year-old Caucasian male with bilateral GBCCs on the dorsal forearms, measuring 130 cm² and 24 cm², respectively, that developed over a 21-year period. Over this period, the patient treated the tumors with herbal remedies. Histologic evaluation showed a conventional nodular BCC for both tumors. Computed tomography and magnetic resonance imaging revealed a T4N0M0 stage for the larger lesion. Surgical excision and grafting and reconstruction were offered, but he declined. This case highlights a shared belief in holistic treatments and rejection of Western medical interventions that are common among many patients with GBCC. Studies reporting nonsurgical treatments for GBCCs, including radiotherapy, vismodegib, topical imiquimod, and acitretin are reviewed.

Denying the Obvious: Four Extreme Cases of Neglected Tumors

BACKGROUND

Little is known about the relatively common phenomenon of patients neglecting tumors as part of a denial mechanism to presumably cope with the obvious, outward and clearly visible signs of cancer. As a result of this tumor neglect, disease progression continues unchecked, resulting in excessive tumor growth, invasion of nearby structures, (often) metastatic spread, and significant disfigurement.

METHODS

In this case series, we present 4 extreme cases of neglected tumors that posed significant reconstructive challenges and explore the biopsychosocial components of tumor neglect.

RESULTS

In this series, we present 4 cases representing various cases of extreme tumor neglect. These 4 cases required multidisciplinary efforts involved in tumor resection, adjuvant treatments and the complex reconstructive efforts after tumor extirpation.

CONCLUSIONS

The tumor neglect phenomenon is of broad interest to the field of plastic and reconstructive surgery. Given the complex patient factors that contribute to the extreme state of disease progress upon presentation, all cases required extensive extirpative efforts with complex and challenging reconstructive solutions. Cases of extreme tumor neglect provide insight into the biopsychosocial underpinnings of this specific patient population and have implications for a further understanding of the potential immunoprotective effect of these large, longstanding, and often nonmetastatic tumors.

Neglected giant scalp Basal cell carcinoma

SUMMARY

Rarely, basal cell carcinoma grows to a giant size, invading the underlying deep tissue and complicating the treatment and reconstruction modalities. A giant basal cell carcinoma on the scalp is in some cases treated with a combination of surgery and radiation therapy, resulting in local control, a satisfactory long-term cosmetic and functional result. We present a case with a neglected basal cell scalp carcinoma, treated with wide excision and postoperative radiotherapy, reconstructed with a free latissimus dorsi flap. The cosmetic result is acceptable and there is no sign of recurrence 1 year postoperatively.

Giant basal cell carcinoma

The basal cell carcinoma is the most common skin cancer but the giant vegetating basal cell carcinoma reaches less than 0.5 % of all basal cell carcinoma types. The Giant BCC, defined as a lesion with more than 5 cm at its largest diameter, is a rare form of BCC and commonly occurs on the trunk. This patient, male, 42 years old presents a Giant Basal Cell Carcinoma which reaches 180 cm2 on the right shoulder and was negligent in looking for treatment. Surgical treatment was performed and no signs of dissemination or local recurrence have been detected after follow up of five years.

Neglected Basal cell carcinoma in axilla

Basal cell carcinoma (BCC) is the most common skin cancer. The most significant risk factor is ultraviolet radiation and the most frequent site of BCC is head and neck, with around 75–80% occurring on face. BCC occurs infrequently in non-sun-exposed skin. The axilla is one of the least sun-exposed areas of our body, and as such BCC at this site is very rare. We present a case of large neglected axillary BCC in a 35- year-old male.

A case of superficial giant Basal cell carcinoma with satellite lesions on scalp

Giant basal cell carcinoma (BCC), defined as a lesion greater than 5 cm at its largest diameter, is a rare variant of BCC. In contrast to small BCC, giant BCC develops on skin that is not exposed to sunlight, including the back, shoulder, groin and thigh. Most of the histopathologic subtypes of giant BCC are micronodular, morpheaform and nodular, but the superficial subtype is rare. Giant superficial BCC arising on the scalp is extremely rare. We report the case of giant superficial BCC with four satellite lesions on the scalp in a 53-year-old male without predisposing factors.

Neglected Basal cell carcinomas in the 21st century

Although tumors on the surface of the skin are considered to be easily recognizable, neglected advanced skin neoplasms are encountered even in the 21st century. There can be numerous causes of the delay in the diagnosis: fear of the diagnosis and the treatment, becoming accustomed to a slowly growing tumor, old age, a low social milieu, and an inadequate hygienic culture are among the factors leading some people not to seek medical advice. The treatment of such advanced neoplasms is usually challenging. The therapy of neglected cases demands an individual multidisciplinary approach and teamwork. Basal cell carcinoma (BCC), the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential; these factors are suggesting that BCCs might well be the “ideal candidates” for neglected tumors. Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009. The clinical characteristics and treatment modalities of these neoplasms are discussed, together with the possible causes of the neglect.

Giant basal cell carcinoma of the thoracic wall: a case report and review of the literature

Giant basal cell carcinoma is a rare skin tumour with aggressive biological behaviour, and deep invasion and metastasis have been reported. The authors describe a giant basal cell carcinoma involving the anterior chest wall. The lesion infiltrated the mediastinum, occluding the left brachiocephalic vein. Vascular invasion caused venous occlusion affecting the left upper limb. Neither surgical treatment nor radiotherapy were practicable.