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Kang AS, Kang G, Kathuria HS. Super giant basal cell carcinoma: a comprehensive systematic review. Ann Med Surg (Lond) 2024; 86:2935-2939. [PMID: 38694394 PMCID: PMC11060294 DOI: 10.1097/ms9.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/25/2024] [Indexed: 05/04/2024] Open
Abstract
Super giant basal cell carcinoma (SGBCC), defined as greater than 20 cm in diameter, is a rare oncological entity, with scarce literature. The authors conducted a review to characterize SGBCC, specifically with regards to age, sex predilection, risk factors, geographical location, body site, metastasis, and treatment. A systematic literature search was conducted from 1972 to 2023. All abstracts, studies, and citations were reviewed. The initial result showed 47 281 articles and were filtered down for human, skin, English language, and SGBCC. The authors identified 20 case reports for our analysis. The sample size was too small to conduct extensive statistical analysis. Majority of the cases were reported in North America and Europe. Males outnumbered almost females 2:1. The mean age was 61 years. The lesion was located on trunk in 16 out of 20 cases. In 13 out of 20 years, the lesion had been present for more than 10 years and 7 out of 20 cases reported metastasis. Several reports documented low socioeconomic status and poor mental health. Regarding treatment, 11 patients underwent surgery, radiation was utilized in 6 patients and immunotherapy (Vismodegib) in 4 patients. Although basal cell carcinoma (BCC) is known to have a favorable prognosis, SGBCC is highly aggressive with ability to metastasize. Our review reveals SGBCC is commonly diagnosed in males in their sixth decade, present for more than 10 years duration, risk factors include low socioeconomic status and poor mental health, commonly found on the trunk with a predilection for metastasis. The authors believe self-neglect is the likely etiology of the large size. Treatment options may be multimodal with a combination of surgery, radiation therapy or immunotherapy (Vismodegib).
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2
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Garmpis N, Dimitroulis D, Garmpi A, Tasioula PI, Damaskos C. Giant Basal Cell Carcinoma in a Renal Transplant Recipient: A Case Report. Cureus 2024; 16:e58956. [PMID: 38800195 PMCID: PMC11126782 DOI: 10.7759/cureus.58956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Basal cell carcinoma is a skin cancer with a more benign clinical course, compared to other skin cancers. However, when left neglected, it can cause serious morbidity and mortality. A basal cell carcinoma larger than 5 cm is defined as giant. Common causes of these carcinomas are negligence, immunosuppression, low socioeconomic status, physical or mental dysfunction, light exposure, exposure to radiation, existence of a previous lesion, recurrence after treatment, and aggressive histologic pattern. In some cases, giant basal cell carcinoma has been described to infiltrate multiple intracranial structures and to be associated with distant metastasis. Herein, we present a case of a giant basal cell carcinoma on the temporary scalp of a renal transplant recipient with depression.
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Affiliation(s)
- Nikolaos Garmpis
- NS Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Department of Surgery, Sotiria General Hospital, Athens, GRC
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Christos Damaskos
- NS Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Renal Transplantation Unit, Laiko General Hospital, Athens, GRC
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3
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Karki S, Parajuli A, Bhattarai B, Kumari K, Harrylal KA, Bhatta P, K. C. M, Sharma S. Neglected Fungating Giant basal cell carcinoma: A case report and literature review. Clin Case Rep 2024; 12:e8765. [PMID: 38601171 PMCID: PMC11004263 DOI: 10.1002/ccr3.8765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024] Open
Abstract
Key Clinical Message Gaint fungating BCC is rare and aggressive. Early health-seeking behavior may result in positive outcomes. Abstract Fungating giant basal cell carcinoma (BCC) is a rare and aggressive form of BCC infrequently reported in the literature. We present a giant BCC case in an old female from a rural area with a poor socioeconomic profile.
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Affiliation(s)
- Susmin Karki
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Asmita Parajuli
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Bhawesh Bhattarai
- Department of SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Khusbu Kumari
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | | | - Pramish Bhatta
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | - Milan K. C.
- Department of SurgeryTribhuvan University Institute of MedicineKathmanduNepal
| | - Samit Sharma
- Department of Plastic SurgeryTribhuvan University Institute of MedicineKathmanduNepal
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4
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Albayati A, Özkan B, Tepeoğlu M, Uysal ÇA. Giant Basal Cell Carcinoma Causing Axillary Contracture: A Case Report of an Unusual Localization of an Advanced Case. Ann Dermatol 2023; 35:S211-S214. [PMID: 38061706 PMCID: PMC10727880 DOI: 10.5021/ad.21.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 12/20/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common type of non-melanoma skin cancer. Although BCC arises most commonly in sun-exposed areas of the body, such as the head and neck, it infrequently can be seen in sun-protected parts as well. Axilla is one of the least encountered areas of BCC. Delay in the diagnosis or management alongside negligence of the patient can lead to a tumor reaching a giant size. We report a case of giant axillary BCC in a 59-years old female patient with no known risk factors for skin cancers. The tumor was excised with wide margins, and the tissue defect was reconstructed with latissimus dorsi musculocutaneous flap. A 3-year follow-up did not show any sign of recurrence or metastasis.
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Affiliation(s)
- Abbas Albayati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
| | - Burak Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Merih Tepeoğlu
- Department of Clinical Pathology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Çağrı A Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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5
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Tchernev G, Kordeva S, Lozev I. Giant basal cell carcinoma of the scalp: rotation advancement flap as a successful dermatosurgical approach. Dermatol Reports 2023; 15:9664. [PMID: 37822986 PMCID: PMC10563025 DOI: 10.4081/dr.2023.9664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/04/2023] [Indexed: 03/09/2023] Open
Abstract
Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, and maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice, from surgical removal, waiting for granulations to form, and placing a split skin mesh graft (at a later stage) to performing complex rotational/transpositional or advancement flaps. Achieving an optimal aesthetic result is often the consequence of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives, such as radiotherapy and targeted therapy with vismodegib, could be administered both preoperatively and postoperatively or as first-line therapy, depending on the tumor board decisions. We present the case of a 69-year-old female patient with a histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not infiltrate the tabula externa. A preoperative ultrasound was performed to preserve the feeding flap arteries. Surgical treatment under general anesthesia was planned and subsequently carried out. During surgery, the surgical resection lines were in close proximity to the arterial vessels, but they remained preserved and ensured a subsequently unproblematic healing process. After the application of the rotational advancement flap technique under general anesthesia, an optimal cosmetic effect was achieved.
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Affiliation(s)
- Georgi Tchernev
- Venereology and Dermatologic Surgery, Onkoderma-Clinic for Dermatology, Sofia
- Department of Dermatology and Venereology, Medical Institute of Ministry of Interior, Sofia
| | - Simona Kordeva
- Venereology and Dermatologic Surgery, Onkoderma-Clinic for Dermatology, Sofia
| | - Ilia Lozev
- Department of Common and Vascular Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria
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6
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Russell E, Udkoff J, Knackstedt T. Basal cell carcinoma with bone invasion: A systematic review and pooled survival analysis. J Am Acad Dermatol 2021; 86:621-627. [PMID: 34273459 DOI: 10.1016/j.jaad.2021.06.889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although basal cell carcinoma (BCC) tends to follow an indolent course, some tumors can exhibit locally aggressive behavior and invade into bone. OBJECTIVE To analyze all published demographic, clinical, and treatment data on recurrence patterns, disease progression, disease-specific death, and overall mortality of BCC with bone invasion. METHODS A systematic review and pooled-survival analysis was performed, including case reports and case series of BCC with bone invasion. RESULTS The study included 101 patients from 70 publications. BCC tumors invading into bone were most often large, neglected tumors located in high-risk face areas. At 5 years, patients had a 30% risk probability of disease recurrence (after negative margins), a 72.1% risk of disease progression or death (with ambiguous margin status), an 18.2% risk of BCC-related death, and a 20.7% overall probability of death. LIMITATIONS Limitations include the reliance on case reports and series for individual patient data, which has the potential to introduce selection bias. CONCLUSION The high rate of disease progression and suboptimal 5-year survival rate highlights the poor prognosis of BCC with bone invasion and further underscores the importance of early detection and treatment.
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Affiliation(s)
- Emma Russell
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy Udkoff
- University of Pittsburgh Department of Dermatology, Pittsburgh, Pennsylvania
| | - Thomas Knackstedt
- Case Western Reserve University School of Medicine, Cleveland, Ohio; MetroHealth System Department of Dermatology, Cleveland, Ohio.
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7
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Yoham AL, Sinawe H, Schnur J, Casadesus D. Aggressive progression of a facial super giant basal cell carcinoma. BMJ Case Rep 2021; 14:14/4/e240617. [PMID: 33858891 PMCID: PMC8054050 DOI: 10.1136/bcr-2020-240617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Super giant basal cell carcinoma (BCC) is a rare oncological entity. A 52-year-old man with a history of a left upper facial lesion for 11 years was transferred to our facility seeking an evaluation. He frequented multiple hospitals where he was treated with antibiotics for this condition. He reported having the Mohs procedure 8 months prior to this hospital visit but he did not follow-up with the other institution. The physical examination revealed an ulcer involving the upper left orbito-fronto-parieto-temporal area with bone exposure. Both CT and MRI of the face and the brain demonstrated dehiscence of the left lateral orbital roof and left frontal bone. The biopsy confirmed advanced BCC. He was discharged against medical advice and lost to follow-up. He returned 1 month later with left eye discharge and vision loss. He was diagnosed with cerebral abscess, treated with antibiotics and discharged to hospice.
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Affiliation(s)
| | - Hadeer Sinawe
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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8
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Kolitz EM, Scott BL, Vandergriff T, Mauskar M. A lobulated mass on the upper back with prominent vasculature: A giant basal cell carcinoma. Dermatol Reports 2021; 13:9046. [PMID: 33936576 PMCID: PMC8056320 DOI: 10.4081/dr.2021.9046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
Basal cell carcinoma (BCC) is characterized by slow but locally invasive growth. Although there is low metastatic potential, if not treated early, these skin cancers can lead to significant morbidity and mortality. In this case report, we present a man with a neglected BCC that developed into what is termed a giant BCC or one that is greater than 5 cm. This tumor was discovered only upon workup of orthostatic lightheadedness and iron deficiency anemia. Although rare, basal cell carcinoma must be included on the differential of a large cutaneous lesion and may be a source of significant blood loss.
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Affiliation(s)
| | | | | | - Melissa Mauskar
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX.,Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
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9
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Hudson E, Abu Hilal M. Super giant basal cell carcinoma in an autistic patient: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20939481. [PMID: 32733678 PMCID: PMC7370554 DOI: 10.1177/2050313x20939481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
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.
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10
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Holzbauer M, Groß S, Huemer GM, Hoetzenecker W, Schmidt M. Giant basal cell carcinoma including focal squamous cell carcinoma of the buttock: A rare case. Dermatol Ther 2020; 33:e13674. [PMID: 32447832 DOI: 10.1111/dth.13674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Matthias Holzbauer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital, Linz, Austria
| | - Susanne Groß
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - Georg M Huemer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital, Linz, Austria
| | - Wolfram Hoetzenecker
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - Manfred Schmidt
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Section of Plastic and Reconstructive Surgery, Department of General Surgery, Kepler University Hospital, Linz, Austria
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11
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Oudit D, Pham H, Grecu T, Hodgson C, Grant ME, Rashed AA, Allan D, Green AC. Reappraisal of giant basal cell carcinoma: Clinical features and outcomes. J Plast Reconstr Aesthet Surg 2020; 73:53-57. [DOI: 10.1016/j.bjps.2019.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/27/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
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12
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Sahned J, Mohammed Saeed D, Misra S, Thakkar D. Giant Ulcerative Basal Cell Carcinoma with Local Metastasis: A Case Report and Assessment of Surgical Techniques. Cureus 2019; 11:e6426. [PMID: 31993264 PMCID: PMC6970455 DOI: 10.7759/cureus.6426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
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.
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13
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Gualdi G, Monari P, Calzavara‐Pinton P, Caravello S, Fantini F, Bornacina C, Specchio F, Argenziano G, Simonetti V, Caccavale S, La Montagna M, Cecchi R, Landi C, Simonacci M, Dusi D, Puviani M, Zucchi A, Zampieri P, Inchaurraga MAG, Savoia F, Melandri D, Capo A, Amerio P. When basal cell carcinomas became giant: an Italian multicenter study. Int J Dermatol 2019; 59:377-382. [DOI: 10.1111/ijd.14728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Giulio Gualdi
- Department of Medicine and Aging Science and Dermatologic Clinic University “G. d'Annunzio”, Chieti‐Pescara Chieti Italy
| | - Paola Monari
- Department of Dermatology University of Brescia, Spedali Civili Brescia Brescia Italy
| | | | - Simone Caravello
- Department of Dermatology University of Brescia, Spedali Civili Brescia Brescia Italy
| | | | | | - Francesca Specchio
- Skin Cancer Unit Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy
| | | | - Vito Simonetti
- Skin Cancer Unit Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy
| | | | | | | | - Christian Landi
- Azienda USL della Romagna Surgical Department U.O. Dermatologia Rimini Italy
| | | | - Daniele Dusi
- Dermatology Unit Ospedale di Macerata Macerata Italy
| | - Mario Puviani
- Dermatology and Dermatologic Surgery Unit Ospedale Sassuolo Modena Italy
| | - Alfredo Zucchi
- Section of Dermatology Department of Clinical and Experimental Medicine Parma University Parma Italy
| | | | | | | | | | - Alessandra Capo
- Department of Medicine and Aging Science and Dermatologic Clinic University “G. d'Annunzio”, Chieti‐Pescara Chieti Italy
| | - Paolo Amerio
- Department of Medicine and Aging Science and Dermatologic Clinic University “G. d'Annunzio”, Chieti‐Pescara Chieti Italy
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14
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Vaca-Aguilera MR, Guevara-Gutiérrez E, Barrientos-García JG, Tlacuilo-Parra A. Giant basal cell carcinoma: clinical-histological characteristics of 115 cases. Int J Dermatol 2019; 58:1430-1434. [PMID: 30972736 DOI: 10.1111/ijd.14455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/21/2019] [Accepted: 03/12/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Giant basal cell carcinoma (GBCC) is a tumor ≥5 cm in size, with aggressive biological behavior, that represents 1% of basal cell carcinomas (BCC), and studies regarding it are scarce. Our objective was to investigate the clinical-histopathological characteristics of GBCC and the risk factors associated with its development. METHODS A retrospective study over 8 years included patients with the clinical and histopathological diagnosis of GBCC. Age, sex, localization, size, evolution time, risk factors, and histological variants were compared to conventional BCC. Descriptive and inferential statistics were used, and a value of P < 0.05 was considered statistically significant. RESULTS Of 5958 patients with BCC, 115 (2%) of them corresponded to GBCC. The average patient age was 73 ± 11 years, and the male sex (52%) and localization on the head and neck (63%) predominated. Average tumor size was 6.6 ± 2.2 cm, evolution time was 96 ± 86 months, and high-grade histological variants (51%) predominated. The group with GBCC had higher age (P < 0.01), greater frequency in the male sex (P = 0.01), longer evolution time (P < 0.01); a greater prevalence of risk factors (24% vs. 16%, P = 0.01), antecedents of other types of cancer (P = 0.03), and of burns (P = 0.03); and a greater frequency of high-grade histological variants (51% vs. 29%, P < 0.01). CONCLUSIONS This is the largest series of GBCC published to date. Findings are similar to those previously reported, although the prevalence found here was greater.
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Affiliation(s)
- Martha R Vaca-Aguilera
- Dermatology Department, Instituto Dermatologico de Jalisco, "Dr. José Barba Rubio", Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Elizabeth Guevara-Gutiérrez
- Dermatology Department, Instituto Dermatologico de Jalisco, "Dr. José Barba Rubio", Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Juan G Barrientos-García
- Dermatology Department, Instituto Dermatologico de Jalisco, "Dr. José Barba Rubio", Secretaría de Salud Jalisco, Zapopan, Jalisco, Mexico
| | - Alberto Tlacuilo-Parra
- Medical Research Division, UMAE Hospital de Pediatria CMNO, IMSS, Guadalajara, Jalisco, Mexico
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15
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Giant Basal Cell Carcinoma – a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Basal cell carcinoma is the most common form of cutaneous cancer. In majority of cases it is locally invasive with slow growth, ranging in size from a couple of milimeters to a couple of centimeters and located primarily on sun-exposed regions. Giant basal cell carcinoma, defined as a tumor that is larger than 5 cm in diameter, is a very rare type of cutaneous malignancy accounting for 0.5-1% of all basal cell carcinomas. We present a case of a 74-year-old man with a 17 x 14 cm giant basal cell carcinoma in the right supraclavicular region. Detailed history revealed that the lesion had started as a papule 15 years before presentation. Despite its growth, the lesion was neglected until admission. Histological examination of skin lesion confirmed superficial and focally infiltrative types of basal cell carcinoma. Electron radiotherapy was administered with 54 Gy total dose delivered in 20 daily fractions which resulted in healing of lesions and adequate response. Thus, definitive radiotherapy can be just as effective as excision when the criteria are met.
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16
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Watson M, Wichmann M, Ganguly T. Cutaneous basal cell carcinoma requiring limb amputation. ANZ J Surg 2018; 89:E560-E561. [PMID: 30562843 DOI: 10.1111/ans.14971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Watson
- Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
| | - Matthias Wichmann
- Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
| | - Timothy Ganguly
- Mount Gambier and Districts Health Service, Mount Gambier, South Australia, Australia
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17
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Purnell JC, Gardner JM, Brown JA, Shalin SC. Conventional Versus Giant Basal Cell Carcinoma, a Review of 57 Cases: Histologic Differences Contributing to Excessive Growth. Indian J Dermatol 2018; 63:147-154. [PMID: 29692457 PMCID: PMC5903045 DOI: 10.4103/ijd.ijd_165_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Giant basal cell carcinoma (GBCC) is defined as a basal cell carcinoma (BCC) exceeding 5 cm in size. While these tumors impart significant morbidity due to local tissue destruction and have a higher rate of metastatic disease than their conventional (smaller) counterparts, reasons for their large size remain unclear. While theories relating to neglect or faster growth rate are often invoked; to date, there has not been a comprehensive evaluation of the histologic features of these large tumors that may contribute to their size. Methods: Histologic features of GBCCs (n = 29) were evaluated and compared to those of conventional BCC (n = 28). Available clinical demographic data were also reviewed. Results: GBCCs, in addition to overall larger size, more often were thicker, displayed ulceration, and showed a more infiltrative growth pattern than their conventional counterparts. These rare tumors also displayed an insignificant increased propensity for a brisk host immune response, and the infiltrate significantly more often included clusters of plasma cells. Conclusions: Most histologic features seen in GBCCs likely reflect their large size. Histologic features alone are unlikely to explain the size of these rare tumors. The possibility of an altered host immune response contributing to the growth of these tumors requires further investigation.
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Affiliation(s)
- J Chase Purnell
- Department of Dermatology, University of Alabama, Birmingham, AL, USA
| | - Jerad M Gardner
- Department of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - J Ahmad Brown
- Arkansas Dermatopathology PLLC, Little Rock, AR, USA
| | - Sara C Shalin
- Department of Dermatology, University of Alabama, Birmingham, AL, USA
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Giant Anterior Chest Wall Basal Cell Carcinoma: An Approach to Palliative Reconstruction. Case Rep Oncol Med 2016; 2016:5067817. [PMID: 28083152 PMCID: PMC5204111 DOI: 10.1155/2016/5067817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/20/2016] [Indexed: 11/17/2022] Open
Abstract
Anterior chest wall giant basal cell carcinoma (GBCC) is a rare skin malignancy that requires a multidisciplinary treatment approach. This case report demonstrates the challenges of anterior chest wall GBCC reconstruction for the purpose of palliative therapy in a 72-year-old female. Surgical resection of the lesion included the manubrium and upper four ribs. The defect was closed with bilateral pectoral advancement flaps, FlexHD, and pedicled VRAM. The palliative nature of this case made hybrid reconstruction more appropriate than rigid sternal reconstruction. In advanced metastatic cancers, the ultimate goals should be to avoid risk for infection and provide adequate coverage for the defect.
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19
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Bellahammou K, Lakhdissi A, Akkar O, Rais F, Naoual B, Elghissassi I, M'rabti H, Errihani H. Metastatic giant basal cell carcinoma: a case report. Pan Afr Med J 2016; 24:157. [PMID: 27795755 PMCID: PMC5072823 DOI: 10.11604/pamj.2016.24.157.9233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022] Open
Abstract
Basal cell carcinoma is the most common skin cancer, characterised by a slow growing behavior, metastasis are extremely rare, and it occurs in less than 0, 1% of all cases. Giant basal cell carcinoma is a rare form of basal cell carcinoma, more aggressive and defined as a tumor measuring more than 5 cm at its largest diameter. Only 1% of all basal cell carcinoma develops to a giant basal cell carcinoma, resulting of patient's negligence. Giant basal cell carcinoma is associated with higher potential of metastasis and even death, compared to ordinary basal cell carcinoma. We report a case of giant basal cell carcinoma metastaticin lung occurring in a 79 years old male patient, with a fatal evolution after one course of systemic chemotherapy. Giant basal cell carcinoma is a very rare entity, early detection of these tumors could prevent metastasis occurrence and improve the prognosis of this malignancy.
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Affiliation(s)
- Khadija Bellahammou
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Asmaa Lakhdissi
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Othman Akkar
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Fadoua Rais
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Benhmidou Naoual
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Ibrahim Elghissassi
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Hind M'rabti
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
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20
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Abstract
Cutaneous malignancies make up the majority of periocular tumors diagnosed and treated by ophthalmologists. In this review, we examine literature regarding ethnic and socioeconomic disparities in incidence and clinical outcomes of the three most common cutaneous periocular tumors: basal cell carcinoma, squamous cell carcinoma, and melanoma. In all three tumor types, the literature shows an increased incidence among two groups: those with lightly pigmented skin and those of higher socioeconomic status. While incidence is high in these groups, clinical outcomes for these patients tend to be good. Those with lower socioeconomic status and ethnic minorities, on the other hand, have a low incidence but are more likely to have poor clinical outcomes. These disparities are likely the result of both biologic and behavioral differences between patients and could provide opportunities for intervention to change risk perception and improve outcomes.
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Affiliation(s)
- Talmage Broadbent
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
| | - Brian Bingham
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
| | - Louise A Mawn
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
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21
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Laraqui H, Sair K. [Moroccan experience on neglected goiters in humanitarian mission in Guinea Bissau: About four observations]. Pan Afr Med J 2016; 22:72. [PMID: 26834925 PMCID: PMC4725659 DOI: 10.11604/pamj.2015.22.72.7935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 11/13/2022] Open
Abstract
La mission humanitaire de notre hôpital militaire médico-chirurgicale en Guinée Bissau avait pour but le rapprochement des soins à la population. Les pathologies rencontrées étaient le plus souvent négligées. Nous rapportons quatre observations de goitres négligés sur une durée de trois mois allant de Mai 2015 à Aout 2015. Nous discuterons les problèmes de pathologies négligées en rapport essentiellement avec le niveau socio-économique bas et l'insuffisance en moyens diagnostiques et thérapeutiques et en personnel de soins qualifiés.
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Affiliation(s)
- Hicham Laraqui
- Service de Chirurgie Viscérale, Hôpital Militaire d'Instruction Mohammed V Rabat, Maroc
| | - Khalid Sair
- Service de Chirurgie Viscérale, Hôpital Militaire d'Instruction Mohammed V Rabat, Maroc
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22
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Giant basal cell carcinoma of the face: surgical management and challenges for reconstruction. The Journal of Laryngology & Otology 2015; 130:176-82. [PMID: 26676100 DOI: 10.1017/s0022215115003333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Giant basal cell carcinoma, in which the tumour measures 5 cm or greater in diameter, is a very rare skin malignancy that accounts for less than 1 per cent of all basal cell tumours. Very few studies have reported on the incidence, resection and reconstruction of this lesion worldwide. METHODS In total, 17 patients with giant basal cell carcinoma of the head and neck region underwent surgical excision and reconstruction at our hospital. Medical charts were retrospectively reviewed and analysed. RESULTS The lesion was usually in the forehead, eyelid, lips or nasal-cheek region. The greatest diameter ranged from 5 to 11 cm, with 5-6 cm being the most common size at the time of presentation. All patients had their tumour resected and reconstructed in a single-stage procedure, mostly with a local advancement flap, and with no post-operative flap failure. CONCLUSION Giant basal cell carcinoma of the head and neck can be successfully treated with a local flap in a single-stage approach.
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23
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Cöloğlu H, Ozkan B, Sener M, Uysal AÇ, Borman H. The management of non-melanocytic skin malignancies of the scalp and calvarium. Indian J Plast Surg 2014; 47:36-42. [PMID: 24987202 PMCID: PMC4075214 DOI: 10.4103/0970-0358.129621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The management of advanced cutaneous malignancies has been controversial. Thirteen patients with nonmelanoma skin neoplasias that had invaded the bone of the calvarium and scalp were treated in our centre. Objective: The purpose of this study was to evaluate our experience in treating these malignancies with scalp resection and full or partial thickness cranium reconstruction. Patients and Methods: From June 2008 to March 2012, thirteen patients with locally advanced tumours of the scalp invading the calvarium were treated with wide local excision of the scalp combined with an underlying craniectomy and dural resection if needed. Results: Using histopathological diagnosis eleven patients were diagnosed with basal cell carcinoma and two patients with squamous cell carcinoma. A full thickness cranium resection was performed in seven patients and partial in six patients. Conclusion: These large cancers occasionally invade adjacent structures, as well as bone, presenting a challenging surgical problem. In general, giant rotational or island scalp flaps and free tissue transfers are needed to close the area. Finding clean margins are an important part of treating patients with bone involvement and can usually be attained using outer tabula curettage thus preventing unnecessary morbidity.
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Affiliation(s)
- Harun Cöloğlu
- Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Burak Ozkan
- Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Mesut Sener
- Anesthesiology Clinic, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Ahmet Çağrı Uysal
- Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hüseyin Borman
- Plastic and Reconstructive Surgery Clinic, Faculty of Medicine, Baskent University, Ankara, Turkey
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24
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Nystrom LM, Gibbs CP, Singhal D, Klodell CT. Giant basal cell carcinoma of the anterior chest wall with bone invasion. Eur J Cardiothorac Surg 2013; 45:945-6. [PMID: 24026857 DOI: 10.1093/ejcts/ezt416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Giant basal cell carcinoma (BCC) of the chest wall is rare and poses challenges related to resection and reconstruction. A 69-year old man presented with giant BCC invading sternum. Wide resection and reconstruction with polymethylmethacrylate and mesh was performed. The soft tissue defect was covered with a pedicled omental flap and skin graft. He developed an infection requiring removal of the mesh construct; however, debridement and antibiotics cleared the infection. This case illustrates the locally aggressive nature of this disease and the need for tertiary-level care.
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Affiliation(s)
- Lukas M Nystrom
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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25
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Vance KK, Pytynia KB, Antony AK, Krunic AL. Mohs moat: Peripheral cutaneous margin clearance in a collaborative approach for aggressive and deeply invasive basal cell carcinoma. Australas J Dermatol 2013; 55:198-200. [DOI: 10.1111/ajd.12071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 04/01/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Karl K Vance
- Department of Dermatology; University of Illinois; Chicago Illinois USA
| | - Kristen B Pytynia
- Department of Otolaryngology, Head and Neck Surgery; University of Illinois; Chicago Illinois USA
| | - Anuja K Antony
- Division of Plastic, Reconstructive and Cosmetic Surgery; Department of Surgery; University of Illinois; Chicago Illinois USA
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26
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Sinha S, Yip MJ, Gill S, Pohl MJ, Donahoe SR. A giant fungating metastatic basal cell carcinoma of the back and novel reconstruction using two large keystone design island perforator flaps. J Plast Reconstr Aesthet Surg 2013; 66:1015-8. [DOI: 10.1016/j.bjps.2013.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/02/2013] [Accepted: 02/20/2013] [Indexed: 11/26/2022]
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27
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Warbrick-Smith J, O'Neill JK, Wilson P. Giant anterior chest wall basal cell carcinoma: a reconstructive challenge and review of the literature. BMJ Case Rep 2013; 2013:bcr-2013-008871. [PMID: 23598936 DOI: 10.1136/bcr-2013-008871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Giant basal cell carcinomas (GBCC) are rare, accounting for <1% of BCCs. Those occurring on the anterior chest wall are a very rare subset that brings particular reconstructive challenges. We describe a 75-year-old man whose 13.5 cm diameter ulcerating GBCC on his left anterior chest came to medical attention following a fall. The lesion was resected en-bloc with adjacent ribs, and reconstructed with an omental flap, superiorly pedicled vertical rectus abdominus myocutaneous (VRAM) flap and split skin grafting. While the myriad reasons for delayed presentation of giant cutaneous malignancies are well documented, the complex nature of reconstruction and requirement for an integrated multidisciplinary approach are less so. It is of importance to note that the cicatricial nature of these lesions may result in a much larger defect requiring reconstruction than appreciated prior to resection. Documented cases of anterior chest wall GBCC and the treatment strategies employed are reviewed.
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28
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SUZUKI S, WATANABE S, KATO H, NAKAMURA M, MORITA A. Case of annular-shaped giant basal cell carcinoma. J Dermatol 2012; 39:933-4. [DOI: 10.1111/j.1346-8138.2012.01511.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Tumeurs « historiques » : tumeurs négligées. Trois observations. Ann Dermatol Venereol 2012; 139:194-8. [DOI: 10.1016/j.annder.2011.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/08/2011] [Accepted: 12/14/2011] [Indexed: 11/21/2022]
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30
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Zoccali G, Pajand R, Papa P, Orsini G, Lomartire N, Giuliani M. Giant basal cell carcinoma of the skin: literature review and personal experience. J Eur Acad Dermatol Venereol 2011; 26:942-52. [DOI: 10.1111/j.1468-3083.2011.04427.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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31
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Heo YS, Yoon JH, Choi JE, Ahn HH, Kye YC, Seo SH. A case of superficial giant Basal cell carcinoma with satellite lesions on scalp. Ann Dermatol 2011; 23 Suppl 1:S111-5. [PMID: 22028555 PMCID: PMC3199405 DOI: 10.5021/ad.2011.23.s1.s111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 08/18/2010] [Accepted: 10/22/2010] [Indexed: 02/06/2023] Open
Abstract
Giant basal cell carcinoma (BCC), defined as a lesion greater than 5 cm at its largest diameter, is a rare variant of BCC. In contrast to small BCC, giant BCC develops on skin that is not exposed to sunlight, including the back, shoulder, groin and thigh. Most of the histopathologic subtypes of giant BCC are micronodular, morpheaform and nodular, but the superficial subtype is rare. Giant superficial BCC arising on the scalp is extremely rare. We report the case of giant superficial BCC with four satellite lesions on the scalp in a 53-year-old male without predisposing factors.
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Affiliation(s)
- Young Soo Heo
- Department of Dermatology, College of Medicine, Korea University, Seoul, Korea
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32
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de Bree E, Laliotis A, Manios A, Tsiftsis DD, Melissas J. Super giant basal cell carcinoma of the abdominal wall: still possible in the 21st century. Int J Dermatol 2010; 49:806-9. [PMID: 20618503 DOI: 10.1111/j.1365-4632.2009.04305.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Basal cell carcinoma (BCC) is very common and usually encountered when it is small in size. Giant BCC (i.e. greater than 5 cm in diameter) is quite rare and comprises 0.5 percent of all BCC. Extremely rarely, tumors larger than 20 cm have been reported. Herein, a case with an enormous, vegetating BCC of the abdominal wall, 30 x 20 cm in size, is described. This report demonstrates that such a case can still be observed in the civilized world of the 21st century, which remains profoundly astonishing. A literature survey was performed and revealed only 7 cases with such super giant BCC (i.e. larger than 20 cm in diameter). Generally, this tumor attains these enormous proportions due to neglect on the patient's part, and is usually located at sites covered by clothes. Treatment is mainly surgical and generally curative, resulting also in an improved quality of life. Tumor size of more than 10 cm in diameter is associated with increased risk for metastatic disease, severe morbidity and consequently impaired prognosis.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete-University Hospital, Herakleion, Greece.
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Abstract
UNLABELLED Eyelid tumors constitute about 40% of all cancers located in the orbital region. Most commonly, they are basal cell carcinomas, in 90% of cases located in the lower eyelid and medial canthus. The purpose of our study was to present the management and to overview the results of surgical treatment of eyelid tumors. MATERIALS AND METHODS One hundred ninety-three patients, 89 men and 104 women, aged 16 to 87 years (mean, 63.5 years) with eyelid tumors were treated in Plastic Surgery Hospital in Polanica-Zdrój in the years 1985 to 2008. The patients were divided into 2 groups: group 1 (n = 148) was composed of patients operated on primarily in our hospital, and group 2 (n = 45) was composed of patients operated on in other hospitals, admitted for recurrence. All the patients underwent surgery involving resection of the tumor and simultaneous eyelid reconstruction. The preparations were evaluated histopathologically. Various surgical modalities were used, depending on the extent and location of the tumor. RESULTS Recurrence developed in 13 patients in group 1 (8.7%; 5 women and 8 men) and in 9 patients in group 2 (20%; 5 women and 4 men). CONCLUSIONS Tumors, usually basal cell carcinoma, originate mainly in the lower eyelid and medial canthus. Surgery should be performed as soon as possible after onset of the primary tumors and should include resection and reconstructive therapy. The highest risk of recurrence is in case of squamous cell and basospinocellular tumors, and especially in melanoma. The aim of reconstructive therapy is to reconstruct aesthetically and functionally effective eyelid.
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34
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Taboada A, Couto I, Brea B, González E, Prieto A. Carcinoma basocelular invasivo de cuero cabelludo. Caso clínico. Neurocirugia (Astur) 2010. [DOI: 10.1016/s1130-1473(10)70090-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Invasive giant basal cell carcinoma of the head: case report, reconstruction choice and literature review. Open Med (Wars) 2009. [DOI: 10.2478/s11536-009-0069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractIt is unusual to find a giant invasive basal cell carcinoma in the occipital region of the head. We are presenting a case of basal cell carcinoma invading and eroding occipital bone, managed with an unusual scalp reconstruction method. A 69-year-old female presented with a 16x19 cm diameter tumour in the occipital region. Preoperative biopsy revealed a basal cell carcinoma. A complete surgical excision of the tumour was performed in one-step surgery and tissue defect was reconstructed by a pedicle latissimus dorsi musculocutaneous flap. Our case shows that this distant pedicle flap is safe and reliable, and should be revised as the option for the occipital region reconstruction.
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36
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Kim JR, Lee NH, Kim YS, Park JH, Yun SK. Pulmonary metastasis from a giant polypoid basal cell carcinoma in the lumbosacral area. Dermatol Surg 2009; 36:128-32. [PMID: 19889160 DOI: 10.1111/j.1524-4725.2009.01366.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jung Ryul Kim
- Department of Orthopedic Surgery, Chonbuk National University, Jeonju, 561-712, South Korea.
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37
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Big Bad BCCs: craniofacial resection and reconstruction for atypical basal cell carcinomata. J Plast Reconstr Aesthet Surg 2009; 63:e433-41. [PMID: 19879202 DOI: 10.1016/j.bjps.2009.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 08/31/2009] [Accepted: 09/04/2009] [Indexed: 01/11/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignancy of the body and most frequently occurs in the head and neck. 'Problematic aggressive' BCCs are either frequently recurrent, often after histologically confirmed clearance, or are 'giant/horrifying' and invasive of critical anatomy. Three patients that illustrate different clinical features and outcomes of 'problematic aggressive' craniofacial BCCs are reported that required craniofacial resection and reconstruction with microsurgical free flap cover, and a re-evaluation of our care pathway for these uncommon presentations.
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38
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Madan V, West C, Murphy J, Lear J. Sequential treatment of giant basal cell carcinomas. J Plast Reconstr Aesthet Surg 2009; 62:e368-72. [DOI: 10.1016/j.bjps.2007.12.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 12/23/2007] [Accepted: 12/29/2007] [Indexed: 11/28/2022]
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39
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Cherian P, Kumarasinghe P. Giant basal cell carcinoma masquerading as an osteogenic sarcoma. Australas J Dermatol 2009; 50:60-3. [PMID: 19178496 DOI: 10.1111/j.1440-0960.2008.00507.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An 88-year-old man presented to the dermatology outpatient clinic with an 11-month history of a rapidly growing mass overlying a clavicular fracture site. The lesion was 8 x 6 cm, painful, fixed to deeper structures and ulcerated. Superficial and deep biopsies yielded invasive basal cell carcinoma. Imaging demonstrated extensive soft tissue invasion into muscle, bone and potentially into the lung parenchyma. Due to complications arising from subsequent diagnostic procedures, the patient declined further invasive tests. The cutaneous lesion was treated with palliative radiotherapy. We explore the literature regarding the tumorigenic effects of peri-fracture cytokines on the biological behaviour of basal cell neoplasms.
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Affiliation(s)
- Paul Cherian
- Department of Dermatology, Royal Perth Hospital, Western Australia, Australia.
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40
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Müller H, Eisendle K, Gastl G, Höpfl R, Zelger B. Palliative therapy of giant basal cell carcinoma with the monoclonal anti-epidermal growth factor receptor antibody cetuximab. Br J Dermatol 2008; 158:1386-8. [DOI: 10.1111/j.1365-2133.2008.08547.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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41
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Abstract
A 72-year-old white man presented with a large cutaneous tumor on his back. The patient said the lesion, mostly asymptomatic, had increased in size for about 7 years. Physical examination revealed a vegetating mass (Figure 1), partially ulcerated, measuring 30 x 20 cm, which easily dripped serum and blood, with small necrotic areas and a sclerotic border. Perilesional skin appeared edematous, probably owing to inflammation and impaired lymphatic flow. Clinically, there was no evidence of lymph node involvement. His family history was noncontributory. Hematologic examination revealed hypochromic microcytic anemia. Laboratory test results showed hyperuricemia and hypercholesterolemia. The patient's history revealed mild hypertension, ischemic cardiopathy treated with percutaneous transluminal coronary angioplasty and anticoagulant drugs, and moderate chronic renal insufficiency. Histologic examination of a biopsy specimen taken from the margin of the lesion displayed a superficial area of ulceration and invasion of the deeper dermis and subcutaneous tissue (Figure 2A and Figure 2B). The tumor mostly showed an adenoid pattern: gland-like structures and cystic spaces sometimes containing amorphous or granular material, surrounded by strands of basaloid cells devoid of any peripheral palisading (Figure 2C). In some areas, the adenoid pattern coexisted with infiltrated areas characterized by thin and elongated strands or cords of basaloid cells with irregular and jagged peripheral contours within a fibrous or edematous stroma (Figure 2D). Basaloid cells often revealed nuclear atypia, marked pleomorphism and hyperchromatism (Figure 2C and Figure 2D). Therefore, a diagnosis of basal cell carcinoma, adenoid subtype, was made. Magnetic resonance imaging showed a 10-cm wide thickening of the subcutaneous layer on the lumbar region, with a partial neoplastic infiltration of the muscle fascia. No evidence of metastases was found with a total body computed tomography scan. Because the patient was taking anticoagulant drugs and had unstable renal and cardiac function, surgical treatment was at least temporarily excluded, and the patient was referred for radiation therapy.
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42
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Lackey PL, Sargent LA, Wong L, Brzezienski M, Kennedy JW. Giant basal cell carcinoma surgical management and reconstructive challenges. Ann Plast Surg 2007; 58:250-4. [PMID: 17471127 DOI: 10.1097/01.sap.0000250842.96272.37] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Basal cell carcinoma is exceedingly common, but tumors >5 cm in size or giant basal cell carcinomas (GBCCs) are rare. We retrospectively review 10 GBCCs in 8 patients treated by aggressive surgical excision and reconstruction in a single operative procedure. With the exception of 1 chest lesion, all GBCCs involved the face or scalp. The 10 large defects were reconstructed with 5 free-tissue transfers, 2 pedicled musculocutaneous flaps, and 3 rotational skin flaps. There has been no evidence of local recurrence or metastasis in a mean follow-up of 29 months. Neglect has a well-established role in the presence of GBCCs, with undiagnosed preexisting medical problems also common. Surgical excision and reconstruction is the treatment of choice and can be readily accomplished in a single procedure with few complications, good oncologic control, and acceptable cosmetic results.
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Affiliation(s)
- Phillip L Lackey
- Department of Plastic Surgery, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN 37403, USA
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43
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Affleck AG, Gore A, Millard LG, Perks AGD, Kulkarni K, Chan S. Giant primary basal cell carcinoma with fatal hepatic metastases. J Eur Acad Dermatol Venereol 2007; 21:262-3. [PMID: 17243972 DOI: 10.1111/j.1468-3083.2006.01834.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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44
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Lorenzini M, Gatti S, Giannitrapani A. Giant basal cell carcinoma of the thoracic wall: a case report and review of the literature. ACTA ACUST UNITED AC 2005; 58:1007-10. [PMID: 16043154 DOI: 10.1016/j.bjps.2005.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 04/18/2005] [Indexed: 11/22/2022]
Abstract
Giant basal cell carcinoma is a rare skin tumour with aggressive biological behaviour, and deep invasion and metastasis have been reported. The authors describe a giant basal cell carcinoma involving the anterior chest wall. The lesion infiltrated the mediastinum, occluding the left brachiocephalic vein. Vascular invasion caused venous occlusion affecting the left upper limb. Neither surgical treatment nor radiotherapy were practicable.
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Affiliation(s)
- M Lorenzini
- Plastic Surgery Department and Burn Centre, Piazzale Stefani 1, Ospedale Civile Maggiore, Borgo Trento, 37100 Verona, Italy.
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Northington M, Tamburin L, Hamza S, Diwan H, Skelton H, Smith K. Giant basal cell carcinoma associated with human papillomaviruses infection. J Cutan Pathol 2004; 31:174-8. [PMID: 14690463 DOI: 10.1111/j.0303-6987.2004.00161.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Different criteria have been used to define giant basal cell carcinoma (BCC). However, the majority of tumors of 10 cm or greater in diameter have a characteristic clinical and histopathologic presentation. As a group, these tumors often show metastatic spread as opposed to all other BCCs that rarely metastasize. We present an additional patient with a giant BCC greater than 100 cm2. This tumor had a characteristic location and infiltrative growth pattern. Unusual features of this tumor included a lack of expression of BCL-2 with a greater proportion of cycling tumor cells expressing proliferation markers than conventional BCC, as well as expression of anogenital human papillomaviruses (HPV) subtypes with oncogenic potential. The association of HPV with BCCs has rarely been studied and may not be identical to HPV-induced genital squamous cell carcinomas. However, the findings in this patient suggest that HPV may play a role in the development of some chronic giant BCCs.
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Affiliation(s)
- Marian Northington
- Department of Dermatology and Pathology, University of Alabama, Birmingham, AL, USA
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Sherman JE, Talmor M. Slow progression and sequential documentation of a giant basal cell carcinoma of the face. Surgery 2001; 130:90-2. [PMID: 11436019 DOI: 10.1067/msy.2001.111705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- J E Sherman
- Department of Surgery and the Division of Plastic Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
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Abstract
Mohs micrographic surgery (MMS) is a specialized type of minimal marginal surgery that offers cure rates superior to other options in the treatment of contiguous skin cancers in selected settings. Developed by Dr. Frederic E. Mohs, the technique originally required in situ tissue fixation before excision. Most Mohs micrographic surgeons now use the fresh tissue technique exclusively. Horizontal frozen histologic sections of the excised tumor permit more complete microscopic examination of the surgical margin than traditional methods. Residual tumor is graphically mapped and malignant extensions are pursued with staged excisions until the tumor is removed. Maximum sparing of tumor-free adjacent tissue is achieved with histologic mapping of the tumor boundaries, thus optimizing subsequent wound reconstruction. The history, techniques, indications, cure rates, and current controversies of MMS are reviewed.
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Affiliation(s)
- D L Shriner
- Department of Dermatology, New Jersey Medical School, Newark, USA
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Horlock N, Wilson GD, Daley FM, Richman PI, Grobbelaar AO, Sanders R, Foy C. Cellular proliferation characteristics do not account for the behaviour of horrifying basal cell carcinoma. A comparison of the growth fraction of horrifying and non horrifying tumours. BRITISH JOURNAL OF PLASTIC SURGERY 1998; 51:59-66. [PMID: 9577321 DOI: 10.1054/bjps.1997.0031] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study compared the clinical features, histological subtype, growth fraction (by Ki67 immunohistochemistry) and proliferation pattern of 22 clinically defined horrifying basal cell carcinoma compared to 81 non horrifying lesions. Late presentation was associated with half of the horrifying tumours. The other half developed horrifying tumours despite early intervention. The horrifying tumours exhibited a variety of histological growth patterns. A total of 50% were infiltrative, 23% nodular and 18% micronodular. There was no difference in the growth fraction or proliferation pattern between horrifying and non horrifying tumours of similar growth pattern (P = ns), although infiltrative tumours in either group exhibited a significantly higher growth fraction than nodular tumours (P < 0.01). This suggests that there is no intrinsic biological difference between horrifying and non horrifying tumours to account for their behaviour. We conclude that late presentation, failed or inadequate early management especially of infiltrative tumours (and other subtypes) determines the development of horrifying tumours.
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Affiliation(s)
- N Horlock
- RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK
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