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Tomasini CF, Fiandrino G, Favale EM, Antoci F, Barruscotti S. Giant Morpheaform Basal Cell Carcinoma Mimicking Scarring Alopecia: Exception Prone to Neglect. Dermatopathology (Basel) 2024; 11:154-160. [PMID: 38921053 PMCID: PMC11202933 DOI: 10.3390/dermatopathology11020016] [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: 02/29/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
A 74-year-old woman in good general health presented with a 5-year history of progressive hair loss over several years, interpreted as female androgenetic alopecia (AGA), and was treated with topical 5% Minoxidil without improvement. The patient's relevant medical history revealed infiltrating, triple-negative apocrine carcinoma of the right breast four years before, treated by quadrantectomy, radiation, lymphadenectomy and chemotherapy, with no recurrence at the last follow-up. On examination, there was an asymptomatic 15 × 15 cm firm and whitish area of scarring alopecia on the central scalp. Dermoscopy revealed multiple arborizing vessels and many telangiectasia. The clinical considerations included mainly cutaneous metastasis of breast carcinoma (alopecia neoplastica), pseudopelade of Broque and morpheaform basal cell carcinoma (BCC). A histopathologic examination revealed characteristic changes of morpheaform BCC with basaloid islands and cords of atypical basaloid cells diffusely infiltrating the dermis, embedded in a sclerotic and hypervascularized stroma. Secondary alopecia neoplastica due to morpheaform BCC on the scalp is an exceedingly rare entity, possessing subtle clinical features that may mimic both scarring and non-scarring alopecia. Delayed recognition may contribute to aggressive behavior and extensive local destruction. Treatment with hedgehog inhibitors in locally advanced BCC of the scalp, both in adjuvant and neoadjuvant modalities, is promising.
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Affiliation(s)
- Carlo Francesco Tomasini
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Giacomo Fiandrino
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.F.); (F.A.)
| | - Emanuele Mario Favale
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
| | - Francesca Antoci
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.F.); (F.A.)
| | - Stefania Barruscotti
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, 27100 Pavia, Italy
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2
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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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3
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Yao Y, Li T, Huang Y, Cheng H. A Case of Giant Basal Cell Carcinoma of the Ear Complicated by Primary Cutaneous Aspergillosis. Clin Cosmet Investig Dermatol 2022; 15:2841-2844. [PMID: 36582849 PMCID: PMC9793728 DOI: 10.2147/ccid.s392871] [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: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
A 78-year-old female patient with right ear agenesis presented with a skin manifestation of approximately 7 cm × 8 cm deep-invasive ulcer with well-defined borders and a small amount of yellow purulent discharge visible at the base, surrounded by pearl-like margins in a dyke-like elevation, covered with a small amount of necrotic tissue and black crust. The disease lasted for more than 20 years and was diagnosed as giant basal cell carcinoma complicated by primary cutaneous aspergillosis after two histopathological examinations of the skin lesions. There are similarities in the clinical manifestations of these two diseases, which need to be differentiated, and the simultaneous complications are infrequent. It has not been reported.
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Affiliation(s)
- Yabo Yao
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Tianhao Li
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Yuanen Huang
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Hongbin Cheng
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China,Correspondence: Hongbin Cheng, Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shi-er-qiao Road, Jinniu District, Chengdu, People’s Republic of China, Email
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4
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Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol 2020; 27:331-353. [PMID: 32618586 DOI: 10.1097/pap.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
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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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6
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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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7
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Rieger UM, Schlecker C, Pierer G, Haug M. Spontaneous Regression of Two Giant Basal Cell Carcinomas in a Single Patient after Incomplete Excision. TUMORI JOURNAL 2018; 95:258-63. [DOI: 10.1177/030089160909500223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Spontaneous regression of small basal cell carcinoma has been reported. For giant basal cell carcinoma, however, no spontaneous regression has been described to date. Case report We present a patient with two independent giant basal cell carcinomas over the left clavicle and the lower back, measuring 7 × 12 cm and 18 × 20 cm, respectively. Both tumors were excised incompletely (R2) and the patient refused follow-up resections. After 52 and 16 months, respectively, no signs of recurrence were observed. Conclusion Incompletely excised giant basal cell carcinomas can regress spontaneously. A watch-and-wait approach after incomplete resection may be pragmatic to avoid mutilating follow-up resections in patients refusing further surgery.
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Affiliation(s)
- Ulrich M Rieger
- Department of Plastic and Reconstructive Surgery, A.ö. Landeskrankenhaus Innsbruck, Innsbruck Medical University, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Christina Schlecker
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Gerhard Pierer
- Department of Plastic and Reconstructive Surgery, A.ö. Landeskrankenhaus Innsbruck, Innsbruck Medical University, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
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8
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Di Lorenzo S, Zabbia G, Corradino B, Tripoli M, Pirrello R, Cordova A. A Rare Case of Giant Basal Cell Carcinoma of the Abdominal Wall: Excision and Immediate Reconstruction with a Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Flap. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1284-1288. [PMID: 29199268 PMCID: PMC5726147 DOI: 10.12659/ajcr.905671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Female, 82 Final Diagnosis: Giant basal cell carcinoma Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Plastic Surgery
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Affiliation(s)
- Sara Di Lorenzo
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Giovanni Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Bartolo Corradino
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Massimiliano Tripoli
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Roberto Pirrello
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
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9
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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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10
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Salih AM, Kakamad FH, Rauf GM. Basal cell carcinoma mimicking pilonidal sinus: A case report with literature review. Int J Surg Case Rep 2016; 28:121-123. [PMID: 27697696 PMCID: PMC5048622 DOI: 10.1016/j.ijscr.2016.09.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/23/2016] [Accepted: 09/24/2016] [Indexed: 11/16/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common malignancy of the sun-exposed area. About 80–85% occur on the head and neck [2] (Lorenzini et al., 2005). It occur rarely in the other area. On the other hand, Pilonidal sinus (PNS) is a common benign disease that accounts for almost 15% of anal suppurations. We report a case of BCC presented with signs and symptoms of PNS.
Introduction Pilonidal sinus is a common benign disease that accounts for almost 15% of anal suppurations while basal cell carcinoma is the most common malignancy of the sun-exposed area occurring mainly on the head and neck. We report a case of basal cell carcinoma presented with signs and symptoms of PNS. A 40-year-old male presented with swelling of the lower back for 2 years. On examination, there was a round, mobile, soft 4 × 2.5 cm mass on the sacrococcygeal area. Ultrasound showed subcutaneous cystic lesion. Clinical diagnosis of PNS was done and excisional biopsy was performed under local anesthesia. The result of the histopathological examination was suggestive for basal cell carcinoma. Conclusion Basal cell carcinoma should not be forgotten in differential diagnosis of superficial mass and abscesses.
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Affiliation(s)
- Abdulwahid M Salih
- Faculty of Medical Sciences, School of Medicine, Department Surgery, University of Sulaimani, François Mitterrand Street, Sulaymaniyah, Iraq
| | - F H Kakamad
- Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, François Mitterrand Street, Sulaymaniyah, Iraq.
| | - Goran M Rauf
- Sulimani Teaching Hospital, Department of Pathology,, François Mitterrand Street, Sulaymaniyah, Iraq
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11
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Abstract
Giant basal cell carcinoma (BCC) is a very rare entity. Usually, they occur due to the negligence of the patient. Local or distant metastasis is present in most cases. Here, we present a case of giant BCC that clinically resembled squamous cell carcinoma and demonstrated no metastasis at presentation.
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Affiliation(s)
- Sudip Sarkar
- Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Pranaya Kunal
- Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Barunesh Kishore
- Department of Dermatology, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Kisalay Ghosh
- Department of Dermatology, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
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12
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Sadr AH, de Kerviler S, Kang N. Cutaneous basal cell carcinoma with endobronchial metastasis. Ann R Coll Surg Engl 2014; 96:e20-1. [PMID: 25245718 DOI: 10.1308/003588414x13946184902244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extremely rare. For this reason, many plastic surgeons, dermatologists and physicians dealing with skin malignancies consider this as a locally invasive malignancy. We present a rare case of metastatic basal cell carcinoma manifested as a bronchial tumour. This case highlights the fact that despite basal cell carcinoma's local invasive potential, the possibility of distant metastasis still exists and clinicians should therefore be cautious about interpreting extracutaneous symptoms. Chest physicians should always consider the possibility of this rare tumour in the lungs in patients with a history of large basal cell carcinomas in the head and neck region.
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Affiliation(s)
- A H Sadr
- Royal Free London NHS Foundation Trust, UK
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13
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Pierer G, Pülzl P, Deluca J, Müller H, Zelger B, Putzer D, Eisendle K. Extraordinary Giant Basal Cell Carcinoma with Full-Thickness Infiltration of the Abdominal Wall: Single-Staged Resection and Simultaneous Reconstruction. J Cutan Med Surg 2014; 18:127-31. [DOI: 10.2310/7750.2013.13083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Basal cell carcinoma (BCC) is the most frequent form of invasive skin cancer. BCCs usually show a slow progression and rarely metastasize; however, around 1% achieve a “giant” size, larger than 5 cm in diameter. Rarely, BCCs larger than 20 cm are reported in the literature. Objective: We report a case of a giant BCC, measuring 25 × 13 × 5 cm, involving the abdominal wall. The article describes the curative surgical procedure, which resulted in an excellent aesthetic result.
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Affiliation(s)
| | - Petra Pülzl
- Authors who contributed equally to this work
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14
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Treatment of giant basal cell carcinomas of the head and neck with aggressive resection and complex reconstruction. J Craniofac Surg 2014; 23:1634-7. [PMID: 23147292 DOI: 10.1097/scs.0b013e31825da652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Basal cell carcinoma is exceedingly common, but giant basal cell carcinomas (GBCCs) are rare. We retrospectively reviewed 34 patients with GBCC on the head and neck region treated with aggressive surgical excision and reconstruction in a single operative procedure.The large defects were reconstructed with 15 free tissue transfers and 20 pedicled muscle, musculocutaneous flaps, and skin flaps. We were able to observe 23 patients for a minimum 5 years after the surgery. Locoregional recurrence and/or distant metastasis were not observed in 22 patients. Only 1 patient with the scalp BCC had local recurrence between the flap and the normal tissue 2 years after the surgery. Recurrent tumor was widely excised and reconstructed with a skin graft. Our results imply that low complications, good oncologic control, and acceptable cosmetic results can be achieved by a 1-stage team approach with aggressive surgical resection and reconstruction.
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15
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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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16
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Volgin VN, Sokolova TV, Kolbina MS, Sokolovskaya AA. Basalioma: epidemiology, etiology, pathogenesis and clinical picture (part 1). VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors present literature data related to the epidemiology, etiology, pathogenesis and clinical course of basalioma. The key classifications are given. As many as 62 references are reviewed.
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17
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Nasser N, Nasser Filho N, Trauczynski Neto B, Silva LMD. Giant basal cell carcinoma. An Bras Dermatol 2012; 87:469-71. [DOI: 10.1590/s0365-05962012000300019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 06/30/2011] [Indexed: 11/21/2022] Open
Abstract
The basal cell carcinoma is the most common skin cancer but the giant vegetating basal cell carcinoma reaches less than 0.5 % of all basal cell carcinoma types. The Giant BCC, defined as a lesion with more than 5 cm at its largest diameter, is a rare form of BCC and commonly occurs on the trunk. This patient, male, 42 years old presents a Giant Basal Cell Carcinoma which reaches 180 cm2 on the right shoulder and was negligent in looking for treatment. Surgical treatment was performed and no signs of dissemination or local recurrence have been detected after follow up of five years.
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18
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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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19
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Jain VK, Verma SS, Verma AS, Munjal KR, Swarnakar B. Basal cell carcinoma over chest wall (sternum) treated with dufourmentel flap: report of a case with review of literature. J Cutan Aesthet Surg 2010; 3:115-8. [PMID: 21031073 PMCID: PMC2956953 DOI: 10.4103/0974-2077.69026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common malignancy of the skin, accounting for approximately 70–80% of all cutaneous cancers. The commonest site of basal cell carcinoma is the face; 80% arise above a line from the corner of the mouth to the ear lobe. The lifetime ultraviolet radiation damage is the most important factor in its pathogenesis, and the vast majority is observed on sun-exposed skin. BCCs can develop in sun-protected areas, but its occurrence is rare. Here we are reporting a case of rare site of BCC with review of literature in a 65-year-old male who presented with a lesion over anterior chest wall. A clinical diagnosis of BCC was made and patient was subjected to excision biopsy. Biopsy revealed it to be a BCC and it was treated with a Dufourmentel flap.
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Affiliation(s)
- Vishal K Jain
- Department of Surgery, SAIMS Medical College, Indore, India
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20
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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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Clinical and histopathologic findings of basal cell carcinomas on completely covered anatomical sites of the body. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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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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Arnaiz J, Gallardo E, Piedra T, Sanz-Jimenez-Rico JR, Trillo Bohajar E, Alonso Pena D. Giant basal cell carcinoma on the lower leg: MRI findings. J Plast Reconstr Aesthet Surg 2007; 60:1167-8. [PMID: 17604240 DOI: 10.1016/j.bjps.2007.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 11/21/2006] [Accepted: 05/22/2007] [Indexed: 10/23/2022]
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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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Caloglu M, Yurut-Caloglu V, Kocak Z, Uzal C. Metastatic giant basal cell carcinoma and radiotherapy. J Plast Reconstr Aesthet Surg 2006; 59:783-4. [PMID: 16782583 DOI: 10.1016/j.bjps.2005.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 12/28/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Murat Caloglu
- Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.
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