A Case of Super-giant Basal Cell Carcinoma Initially Diagnosed as Multiple Traumas

Abstract

Summary: Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers.

Super giant basal cell carcinoma: A comprehensive systematic review

“…Lymphadenectomy may be considered in cases of lymphatic spread 8 . There is a definite role for Mohs surgery for complete excision 25 . Patients with large exophytic lesions amenable to resection did rather well in terms of mortality compared with the patients who were not surgical candidates 9 , 11 .…”

“…In 2012, United States Food and Drug Administration approved orally available Vismodegib, a hedgehog pathway inhibitor, for locally advanced and metastatic BCC 2 , 9 , 19 , 25 . Despite the relatively low response rates of 30 and 43% for metastatic and locally advanced BCC, this is still a viable option 2 .…”