Neglected skin cancer in the elderly: a case of basosquamous cell carcinoma of the right shoulder

Abstract

Skin cancer remains the most common cancer worldwide, and basal cell carcinoma represents the largest portion of non-melanomatous skin cancers with over 3 million cases diagnosed annually. Locally advanced disease is frequently seen in the elderly posing clinical challenges regarding proper treatment.We report on an 86-year-old female presenting with fatigue, anemia and a large ulcerated skin lesion along the right upper back. A biopsy of the lesion revealed a basosquamous cell carcinoma. She underwent a wide local excision with complex wound reconstruction.Neglected skin cancers in the elderly can present difficult clinical scenarios. There are associated adjuvant therapies that should be considered following resection, such as local radiation therapy and other novel therapies. Newer therapies, such as with vismodegib, may also be considered. A comprehensive, multimodal approach to treatment should be considered in most cases of locally advanced, non-melanoma skin cancers.

Symptomatic iron deficiency anemia from neglected giant basal cell carcinoma

“… 1 In contrast, reports of acute or chronic anemia correlated with nonmetastatic, giant BCC are rare, with only 10 identified by review of the literature ( Table I ). Al-Hadithy et al, 1 Bisgaard et al, 4 and Higgins and Hull 5 outlined 3 cases of giant BCC resulting in chronic iron deficiency anemia without an otherwise identified source in women aged 77 to 86 years. Six additional cases were identified in men aged 33 to 72 years ( Table I ).…”

“…Among these 9 patients, medical history was significant only for well-controlled hypertension, hyperlipidemia, ischemic cardiomyopathy status post coronary artery bypass graft surgery, and atrial fibrillation. 1 , 4 , 6 , 7 Lesions predominantly arose in sun-exposed areas, including the head or neck, apart from 2 reports of lesions arising on the upper back and anterolateral aspect of the chest wall. 4 , 8 Regional lymphedema was identified in only 1 case, with no reports of systemic dissemination.…”

“… 1 , 4 , 6 , 7 Lesions predominantly arose in sun-exposed areas, including the head or neck, apart from 2 reports of lesions arising on the upper back and anterolateral aspect of the chest wall. 4 , 8 Regional lymphedema was identified in only 1 case, with no reports of systemic dissemination. 1 All cases were attributed to neglect or denial, with a 9.6-year average growth time, an average hemoglobin level of 6.1 g/dL, and an average mean corpuscular volume of 60.8 μm 3 .…”

“… 1 All cases were attributed to neglect or denial, with a 9.6-year average growth time, an average hemoglobin level of 6.1 g/dL, and an average mean corpuscular volume of 60.8 μm 3 . 1 , 4 , 5 , 6 , 8 , 9 In addition to anemia-related symptoms such as fatigue, palpitations, and dyspnea on exertion, BCC-related comorbid conditions included chronic sepsis. 8 Patients achieved negative margin results with full recovery after reconstructive surgery, blood transfusions, and close follow-up.…”

Lateral Forehead Flap in Neglected Giant Basal Cell Carcinoma of the Nose: A Case Report

“…Patient factors include low social milieu, unhygienic culture, low knowledge on skin tumor, old age and multiple medical comorbidities. Disease factors include the painless, slow-growing and low metastatic rate of neoplasm [6,[9][10]. In this case, neglect is caused by the economic factor.…”