A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap

Abstract

Patient: Female, 82Final Diagnosis: Giant basal cell carcinomaSymptoms: AnemiaMedication: —Clinical Procedure: —Specialty: Plastic SurgeryObjective:Rare diseaseBackground:Basal cell carcinoma (BCC) greater than 5 cm in diameter is called giant basal cell carcinoma (GBCC), or super giant basal cell carcinoma if it has a diameter larger than 20 cm. Giant BCC only accounts for 0.5% of BCCs and super giant BCC is exceedingly rare. On account of their rarity, there are no established guidelines for GBCC treatment.Case Report:We describe a peculiar case of an 82-year-old woman with a GBCC carcinoma of the lower abdominal wall. The tumor was surgically removed with ipsilateral inguinal lymph nodes and the abdominal wall was reconstructed immediately with a pedicled deep inferior epigastric artery perforator (DIEP) flap.Conclusions:Treatment of giant basal cell carcinoma is often difficult, especially in elderly patients with poor general health and multiple pathologies. The pedicled DIEP flap is rotated to cover the loss of substance without tension, and it is easy to harvest and transfer. This flap allowed a good result without local or systemic complication. We present this report as a reminder of the occasional occurrence of extremely aggressive BCCs. We believe that, especially for rare tumors like these, it is very useful for the entire scientific community to publish these cases and the therapeutic strategies used to treat them.

A lobulated mass on the upper back with prominent vasculature: A giant basal cell carcinoma

“…1,3 In contrast to the very low metastatic incidence of BCCs overall (0.03%), the rate has been reported to be as high as 45% in tumors greater than 10 cm and 100% in tumors greater than 25 cm. 11 The most common sites of metastasis are the lymph nodes and lungs, with a mean survival after metastatic spread of only 8-14 months. 11,12 Although minor bleeding has been associated with BCCs secondary to tissue friability common to these neoplasms, only 10 cases of acute or chronic anemia subsequent to giant BCC have been reported.…”

Super giant basal cell carcinoma in an autistic patient: A case report

“…1 Literature review found only 11 cases reported. 2,3 In contrast to BCCs, which are often found in the sun-exposed areas of the head and neck, GBCCs are located predominantly on the back, where they go unnoticed by the patient and can remain hidden under clothing. 4 There is a greater propensity for metastasis, particularly after reaching a size of 10 cm.…”

“…These risk factors are shared by GBCC, but larger tumors have additional risk factors including an aggressive histological subtype, recurrence after previous treatment, a history of radiation exposure, or a history of neglect. 3 They are most often reported in those with low socioeconomic status, and physical or mental disability which impedes access to health care. 4 Autism has been found to obstruct use of healthcare through several mechanisms, including fear or anxiety, difficulty communicating with the practitioner, and sensory difficulties with the busy clinics.…”

Giant basal cell carcinoma

“…Neglect is responsible for one third of the case of giant basal cell carcf. Some authors have suggested that Giant basal cell carcinoma is cigarette smoking-related in more than 50% of the cases [5].Giant BCC could sometimes show an aggressive behavior [6][7]. Giant BCC is a rare variant that infiltrated dermis and frequently involves extradermal structures [6].…”

“…Giant BCC should be treated aggressively and closely monitored. Treatment relies mainly on surgery with wide local excision usually followed by reconstruction with skin grafts or free flaps [6]. Giant BCC is rarely reported in the literature.…”