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

Abstract

Basal cell carcinoma is the most common skin cancer in the world and is generally treated when small in size with an excellent prognosis. Rarely, basal cell carcinoma will grow to be larger than 5 cm, at which point they are termed giant basal cell carcinoma. Giant basal cell carcinoma comprises only 0.5% of all basal cell carcinoma, but is associated with impaired quality of life and increased risk of metastasis. When a basal cell carcinoma grows to over 20 cm in size, it is termed super giant basal cell carcinoma. Here, we report a case of both a super-giant basal cell carcinoma and a giant basal cell carcinoma developing over 10–12 years on the upper back and anterior chest wall of an autistic male. Generally, this presentation is associated with neglect on the part of the patient. This case report demonstrates a super-giant basal cell carcinoma developing secondary to patient neglect in the context of comorbid mental illness.

Metastatic insidious super giant basal cell carcinoma

“…Due to the rarity of SGBCC, it is difficult to define its characteristic presentation, pathological features, or treatment strategies. Literature review suggests that the average age of presentation is during the sixth decade of life, with an average duration of evolution over 15 years and it is more prevalent in Caucasian males 6. In African Americans, BCC is a rare diagnosis and SGBCC seems to be virtually non-existent 7.…”

“…In one case, the lesion was located on the lower leg and was misdiagnosed as a venous ulcer delaying time to diagnosis by 2 years 9. The role of mental health disorders in SGBCC is highlighted in a case of a middle-aged man with autism with SGBCC, which had progressed unnoticed over 10–12 years 6. A delay in diagnosis was attributed to self-neglect in most cases, perhaps contributing to poorer outcomes.…”

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

“…Prior to this case, approximately 14 cases of basal cell carcinomas greater than or equal to 20 cm have been reported in the literature. 4,[6][7][8][9][10] When they exceed 20 cm, they are termed super giant BCCs. 7 The primary cause of a giant BCC is attributable in the majority of cases to either tumor neglect or local recurrence of a previously treated lesion.…”

“…4,[6][7][8][9][10] When they exceed 20 cm, they are termed super giant BCCs. 7 The primary cause of a giant BCC is attributable in the majority of cases to either tumor neglect or local recurrence of a previously treated lesion. 4,[6][7][8][9][10] Relative to smaller tumors, giant BCCs are more likely to be of a histologically aggressive subtype (morpheaform, micronodular, metatypical) and are more likely to recur following simple excision.…”

“…7 The primary cause of a giant BCC is attributable in the majority of cases to either tumor neglect or local recurrence of a previously treated lesion. 4,[6][7][8][9][10] Relative to smaller tumors, giant BCCs are more likely to be of a histologically aggressive subtype (morpheaform, micronodular, metatypical) and are more likely to recur following simple excision. 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.…”