Giant Ulcerative Basal Cell Carcinoma with Local Metastasis: A Case Report and Assessment of Surgical Techniques

Abstract

Giant basal cell carcinoma (GBCC) is a rare skin cancer characterized by an aggressive biological behavior with extensive local invasion, frequent metastasis, and associated poor prognosis. Wide local excision with sentinel lymph node biopsy is often warranted for this condition, and reconstruction by local rotational flap is one of the best surgical techniques for repairing similar skin cancers with a relatively large skin defect. A 59-year-old man who was a former construction worker with a significant smoking history presented with a single giant suspicious chronic ulcerating skin lesion measuring 9 x 7 cm that proved to be a basal cell carcinoma (BCC) on his left shoulder. The patient was negative for enlarged or palpable lymph nodes and underwent a wide local excision and primary repair with a local flap. Despite negative margins, his follow-up visits at six, nine, and 10 months revealed numerous suspicious lesions that further required multiple local wide excisions that showed new basal cell carcinoma and recurrence to the left axilla. Given the invasiveness of his skin cancer, he was referred to oncology and later treated by chemoradiation. Patients with multiple risk factors are associated with a higher incidence of more invasive skin cancer due to possible cumulative effects. The therapeutic approach for GBCC should involve multidisciplinary teams, with wide local resection of the tumor with possible sentinel lymph node biopsy, local rotational flap for reconstruction of the wide defect, and adjuvant chemoradiotherapy if necessary.

Neglected Fungating Giant basal cell carcinoma: A case report and literature review

“…In the case of inoperable or clinically advanced BCC, sonic hedgehog inhibitor targeted therapy such as vismodegib and sonidegib is the most recent advance in the field of BCC 10,19 . The role of topical imiquimod 5% cream in giant BCC has been shown 20 . Optimal management of giant BCC consists of wide local excision with histologically confirmed tumor‐free margins with or without radio chemotherapy and consideration of regional lymph node dissection only in case of lymph node involvement 1,21 …”

“…10,19 The role of topical imiquimod 5% cream in giant BCC has been shown. 20 Optimal management of giant BCC consists of wide local excision with histologically confirmed tumor-free margins with or without radio chemotherapy and consideration of regional lymph node dissection only in case of lymph node involvement. 1,21 BCC rarely metastasizes, with a median survival of up to 14 months after the metastasis.…”

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

“…6 Wide and deep surgical excision is the mainstay curative treatment of giant BCC. 13 The ideal margin size for large BCC is unknown given the rarity of the tumor, but recommendations vary from 5 mm to 1 cm. 2,[4][5]13 Mohs micrographic surgery offers the advantage of assessing for residual tumor at the time of operation and has been recommended as the treatment of choice for lesions in cosmetically sensitive regions.…”

“…13 The ideal margin size for large BCC is unknown given the rarity of the tumor, but recommendations vary from 5 mm to 1 cm. 2,[4][5]13 Mohs micrographic surgery offers the advantage of assessing for residual tumor at the time of operation and has been recommended as the treatment of choice for lesions in cosmetically sensitive regions. 2,14 Additional treatments can be considered including oral treatment with hedgehog pathway inhibitors, vismodegib and sonidegib, approved in 2012 for those with locally advanced, metastatic, or inoperable BCC.…”

Basal Cell Carcinoma: A Series of Cases Optometry Should Not Miss

“…3,4 Although BCC is slow-growing and rarely metastasizes, undiagnosed lesions have a propensity to become highly infiltrative and create significant structural and cosmetic damage. 5 Primary eye care providers, including optometrists, are ideally positioned to identify suspicious skin lesions in the high-risk facial area, and should be well-versed in the identification and treatment of BCC to ensure the proper care of affected patients. The following is a brief case series consisting of a basal cell masquerader followed by two presentations of basal cell carcinoma of increasing severity, and a review of clinical features and various treatment options for BCC.…”