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Background Management of facial extensive recurrent basal cell carcinoma can be a challenge for dermatologists. Although the preferred technique is usually Mohs surgery, sometimes the patient’s condition or predicted aggressive surgery make other options advisable. Methods We describe a case of a giant recurrent basal cell carcinoma in the face of an old woman successfully treated by combined therapy with MAL-photodynamic therapy and topical 5%. Results The patient remains well and with no sign of the tumor, with very good cosmetic result two years after treatment. Conclusions Management of extensive facial basal cell carcinoma with combined therapies, as photodynamic therapy followed by topical imiquimod, can be an option for selected cases such as ours.

Management of facial extensive recurrent basal cell carcinoma can be a challenge for dermatologists. Although the preferred technique is usually Mohs surgery, sometimes the patient's condition or predicted aggressive surgery make other options advisable.We describe a case of a giant recurrent basal cell carcinoma in the face of an old woman successfully treated by combined therapy with MAL-photodynamic therapy and topical 5%.The patient remains well and with no sign of the tumor, with very good cosmetic result two years after treatment.Management of extensive facial basal cell carcinoma with combined therapies, as photodynamic therapy followed by topical imiquimod, can be an option for selected cases such as ours.

A 69-year-old woman with a history of hypertension and essential tremor was diagnosed with a Burkitt-like diffuse large-cell lymphoma. She received chemotherapy with cyclophosphamide, vincristine and adriamycin (HyperCVAD). Ten days after starting the second cycle of chemotherapy (HyperCVAD), she presented with well-defined, intense, erythematous macules which coalesced to form a symmetric diffuse erythema located on the upper back. Later, the lesions progressed and affected the lower back and perineal areas, extending to the groin. In a few days, a gradual diminution of the erythema was seen, with subsequent development of postinflammatory gray-brownish hyperpigmentation. On the lower back, there were also superficial erosions. Some asymptomatic, closely grouped, gray papules, vesicles, and blisters were found in the groin, resembling the typical lesions of herpetic infection (Fig. 1). Two biopsies of the groin and one of the upper back were performed, and were processed for histopathologic and microbiologic study. Figure 1. Closely grouped gray papules, vesicles, and blisters on the groin mimicking a herpetic infection Download figure to PowerPoint The histopathologic study showed epidermal hyperplasia with acanthosis and papillomatosis. In both biopsies, eccrine ducts covered by mature squamous epithelium were found in the reticular dermis (Fig. 2a−c). In the sample from the groin, an intracorneal bulla was found. Numerous normal isolated cornified cells were seen within the lumen of the bulla (Fig. 2d). An inflammatory mononuclear infiltrate was also present in a periductal and perivascular distribution. No multinucleation, ground-glass nuclei, or peripheral margination of chromatin were found. Therefore, no morphologic evidence of herpes virus infection was present. Figure 2. Low (a), medium (b), and high (c) magnification showing epidermal hyperplasia and squamous syringometaplasia involving dermal eccrine ducts. (d) Medium power magnification of the intracorneal bulla (hematoxylin and eosin staining; a, ×40; b, ×100; c, ×400; d, ×100) Download figure to PowerPoint Cultures and serologic analyses for herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and cytomegalovirus (CMV) were negative. The lesions were treated with topical corticosteroids, with a good response in a few days.