The woman with unexplained anaemia

Abstract

A 77-year-old woman was admitted to hospital for 3 weeks to treat cellulitis and investigate unexplained anaemia. Earlier, when her neck had been examined on outpatient review of her lymphoedema, a large fungating tumour had been noted. This was biopsied and found to be a mixed basaloid adenocarcinoma. She was subsequently admitted under the plastic surgeons and treated with wide local excision on postero-lateral neck dissection. The defect was reconstructed with a deltopectoral flap.

Symptomatic iron deficiency anemia from neglected giant basal cell carcinoma

“…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 m 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.…”

“…Iron deficiency anemia is also prevalent in the general population, with estimates of 2% to 5% in adults and postmenopausal women. 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.…”

“…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 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).…”

“…Basal cell carcinomas (BCCs) comprise the largest portion of malignant neoplasm globally and predominantly affect white men between the fourth and sixth decade of life. 1 In cases of giant BCCs (>5 cm), approximately one-third arise from neglect in the setting of psychosocial factors: denial, poor access to care, cultural practices, etc. Secondary influences, such as localized bleeding or pain, generalized fatigue, or familial encouragement, typically serve as the impetus for seeking medical care.…”