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Key Clinical Message: Gaint fungating BCC is rare and aggressive. Early health‐seeking behavior may result in positive outcomes. 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. [ABSTRACT FROM AUTHOR]

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.

The article presents clinical case report of primary giant nodular basal cell skin cancer in two patients at the age of 64 and 68 years and with disease duration of 20 and 15 years respectively. Psychological status of fear and anxiety are considered the main reasons for the late health encounter. The clinical picture of the case report was characterized by a slow long-term asymptomatic growth of solitary tumor-like mushroom-shaped nodes of stagnant pink color with a bumpy surface, densely elastic consistency, adherent to underlying soft tissues and sized 9.5 7.0 cm and 5.0 9.0 cm respectively. Giant basaliomas were located on the scalp in a woman and on the trunk skin in a man. The clinical tumors features are corresponded to those of a large conglomerated basal cell skin cancer. The article also presents a description of the clinical and dermatoscopic picture of giant nodular basaliomas. The patients underwent curative surgical excision of tumors with pathomorphological examination of the postoperative material. The histological picture of giant basal cell carcinoma in both cases is represented by tumors of a complex structure, namely a solid adenoid type with invasion into the reticular dermis and subcutaneous fat. The low biological potential of giant nodular basaliomas has been established.

Yabo Yao, Tianhao Li, Yuanen Huang, Hongbin Cheng Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of ChinaCorrespondence: 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 chenghongbin@cdutcm.edu.cnAbstract: 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.Keywords: giant basal cell carcinoma, primary, cutaneous aspergillosis

Basal cell carcinoma (BCC) is the most frequently occurring type of all cancers, and represents 80% of all skin cancer. The estimated lifetime risk for BCC in the white population is between 33% and 39% for men and 23% and 28% for women. Its incidence doubles every 25 years and is increasing in the young population. Death is uncommon and seems to decrease in the last years, probably due to early and better diagnosis. BCC arises from abnormal and uncontrolled growth of basal cells. It is a slow‐growing tumor, therefore usually curable at an early stage with surgery or alternative treatment, such as cryotherapy, laser, photodynamic therapy, retinoids and topical agent like 5‐Fluorouracil cream, imiquimod cream, and so forth. Topical treatment of superficial basocellular carcinoma is a viable option, when surgery is not an advisable treatment, especially in the case of giant basocellular carcinoma. In this subtype, imiquimod 5% cream can be a safe and effective treatment, but there are few reports in available literature. We present our case series of eight patients with superficial giant basocellular carcinoma successfully treated with imiquimod 5% cream, which showed clinical improvement after 8 weeks of treatment. [ABSTRACT FROM AUTHOR]

Abstract Basal cell carcinoma (BCC) is the most frequently occurring type of all cancers, and represents 80% of all skin cancer. The estimated lifetime risk for BCC in the white population is between 33% and 39% for men and 23% and 28% for women. Its incidence doubles every 25 years and is increasing in the young population. Death is uncommon and seems to decrease in the last years, probably due to early and better diagnosis. BCC arises from abnormal and uncontrolled growth of basal cells. It is a slow‐growing tumor, therefore usually curable at an early stage with surgery or alternative treatment, such as cryotherapy, laser, photodynamic therapy, retinoids and topical agent like 5‐Fluorouracil cream, imiquimod cream, and so forth. Topical treatment of superficial basocellular carcinoma is a viable option, when surgery is not an advisable treatment, especially in the case of giant basocellular carcinoma. In this subtype, imiquimod 5% cream can be a safe and effective treatment, but there are few reports in available literature. We present our case series of eight patients with superficial giant basocellular carcinoma successfully treated with imiquimod 5% cream, which showed clinical improvement after 8 weeks of treatment.

Basal cell carcinoma (BCC) is the most common skin cancer in the fair-skinned adult population over 50 years of age and the incidence is rising. Generally, BCC has an indolent course, low mortality and a good prognosis due to low rates of metastasis. Giant basal cell carcinoma is a rare reported oncological entity which accounts for 0.5% to 1% of all cases of BCC and has a diameter larger than 5cm. Basosquamous carcinoma is a rare high-risk type of BCC with clinical and histopathological features of both BCC and squamous cell carcinoma. A 61-year-old female presented to our clinic for a giant bleeding tumor located under her left breast. She initially noted the tumor almost 15 years ago. Although the patient was a nurse, she was afraid to seek medical advice until an episode of significant bleeding. At presentation the tumor was a 15/7cm in size, was invading the underlying structures and had a central ulceration. The margins of the tumoral plaque had several nodules and pearly structures suggesting the possible clinical diagnosis of BCC. [ABSTRACT FROM AUTHOR]

Abstract There have been limited reported cases of pedunculated basal cell carcinoma(BCC). Our case is original, and it combines two rare aspects of CBC: Pedunculated and giant. This uncommon aspect is rarely encountered.

Basal cell carcinoma (BCC) is a low-grade malignant tumor that if properly managed has an excellent prognosis. Development of BCC outside the skin areas exposed to sun rays is infrequent. Giant BCC is a rare entity, especially in unexposed areas of the body. It carries a considerable implication on patients' quality of life because of the risk of being a source of infection that may progress to severe sepsis and/or metastasis. An old female presented with a long-standing solitary lesion measuring 7.5x6 cm overlaying the lumber 4-5 vertebral region about 2.5 cm from the line of the sacral promontory. No lymph nodes or distant metastases were detected. For many years, it was misdiagnosed by other physicians as eczema, psoriasis, and fungal infection and accordingly failed to respond to treatment. A histopathological examination of lesional punch biopsy assured the diagnosis of giant superficially spreading BCC. The lesion was excised with a circumferential safety margin of about 5 mm. During the follow-up period of 4 years, no recurrence was detected. Despite being a long-standing Giant basal cell carcinoma (GBCC) in a sun-hidden skin area, the growth behaved as a locally malignant lesion without metastasizing. A wide local surgical excision of the GBCC with 5 mm safety margins was feasible, safe, and with a good aesthetic outcome. Importantly, family practitioners should avoid such missed cases through accuracy in their diagnosis and early referral of any atypical cases to a dermatologist., Competing Interests: The author declares no competing interests., (Copyright: Ghadah Alhetheli et al.)

A 65-year-old man presented with a slowly enlarging, hyperplastic cutaneous nodule on the abdomen that developed over a period of 20 years. Based on the clinical manifestation and typical histopathology, the patient received a diagnosis of giant basal cell carcinoma.

Abstract We report a woman with two giant Basal cell carcinomas (BCCs) on the back, the largest with 12 cm in diameter, inside a vitiligo plaque. They were metatypical subtype BCC associated with a nodular subtype area. Thinking of BCC in vitiligo lesion is extremely important. Giant BCC and vitiligo are rare association.

BACKGROUND: Skin cancer is one of the most frequent malignant neoplasms worldwide; in this group the basal cell carcinoma is the most common; nevertheless, different clinical variants exist that modify the natural evolution of the disease. CLINICAL CASE: A 50-year-old male patient with history of uncontrolled schizophrenia in who a giant basal cell carcinoma was found, but, in spite of its size and evolution, no invasion to deep tissue was found. CONCLUSIONS: Giant basal cell carcinoma is a rare and aggressive subtype of basal cell carcinoma and, therefore, requires multidisciplinary management, with some difficulties in choosing the appropriate treatment. [ABSTRACT FROM AUTHOR]

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.

Giant basal cell carcinoma (GBCC) is a rare subgroup of basal cell carcinomas with a diameter of >5 cm. Current evidence about determining factors is conflicting, suggesting patient neglect, on the one hand, and biologically aggressive behaviour, on the other, with outcomes varying from clearance to death. We aimed to clarify the natural history of GBCC and its response to treatment. We extracted information from clinical records of all patients with GBCC treated from 1998 to 2017 in a tertiary oncology hospital in northwest England. Associations between patient and tumour characteristics were investigated, and modes of treatment and outcomes were assessed. In the 20-year study period, 43 patients (median age 76 years; 23 (53%) female), 3 of whom had Gorlin syndrome, were treated for GBCCs. Median diameter was 6.3 cm, and median time to presentation was 5 years. Seven (16%) GBCCs arose from recurrent BCC, while the majority (84%) presented de novo. The size of GBCC was significantly correlated with delay in presentation (p = 0.03) but not with age or sex. Of 41 patients receiving definitive treatment, 19 GBCCs were treated by excision with ≤1 cm margin and none recurred during follow-up, compared with 10 recurrences of 23 treated with photodynamic therapy (PDT), and 1 of 7 recurred after radiotherapy. Two of 43 patients with GBCC (<5%) presented with extensive local invasion, one of whom also had distant metastases, and both died of the disease. The majority of GBCCs are not clinically aggressive and respond to conservative surgical treatment with a low risk of recurrence. [ABSTRACT FROM AUTHOR]

Giant basal cell carcinomas (GBCCs) are large basal cell carcinomas (BCCs;

• Giant basal cell carcinomas are rare and potentially aggressive tumors. • Aggressive surgical resection with suggested wide free margins is suggested. • Soft tissue reconstruction for back lesions may be challenging. • The O-Z flap represents a safe and reliable alternative for back reconstruction. Giant basal cell carcinomas are rare and potentially aggressive skin malignancies that are infrequently reported in the Literature, and they usually require aggressive surgical resection and immediate soft tissue reconstruction with skin grafts or flaps. The large size of GBCCs has relevant implications not only for the metastatic potential, but even for the reconstructive challenging due to the possible limited availability of tissues for flap coverage. We report the peculiar case of an old patient who underwent to GBCC resection of the back measuring 16 × 13 cm, and immediate reconstruction with a large O to Z flap harvested from the back; one-year follow-up examination revealed a satisfactory result and no recurrence of the disease was observed. The review of the Literature showed that reconstructive options are mainly determined by the site and extent of the defect, exposed structures and patient characteristics and comorbidities, and previous series reported the use of skin grafts only, pedicled myocutaneous or perforator flaps, exclusively free flaps and a combination of techniques. Therefore, in this scenario local flaps such as O-Z flaps are less invasive procedures, that usually have lower rate of postoperative complications and shorter hospitalization compared to more complex procedures. Despite the use of O-Z flap is quite unusual for back reconstruction, we believe that this flap represents a valid and safe alternative in selected cases, particularly in the elderly and medically compromised patients with multiple comorbidities. [ABSTRACT FROM AUTHOR]

We report a woman with two giant Basal cell carcinomas (BCCs) on the back, the largest with 12 cm in diameter, inside a vitiligo plaque. They were metatypical subtype BCC associated with a nodular subtype area. Thinking of BCC in vitiligo lesion is extremely important. Giant BCC and vitiligo are rare association. [ABSTRACT FROM AUTHOR]

Objective: Although frequently regarded as a low grade malignancy, basal cell carcinoma (BCC) sometimes shows aggressive behavior. Giant BCC is defined as a lesion greater then 5 centimeter. Material and Methods: The authors described the diagnosis and treatment protocol of giant BCC, involving lumbosacral region without any local or distant metastasis. Also the authors went through a thorough a retrospective literature research of giant BCCs in terms of frequency and treatment. Results: Giant BCCs are biologically more aggressive; however, patient’s negligence is a key factor for the tumor size. İnternational medical database (PubMed) search reveals 253 giant BCCs with the most commonly seen site as the face and back area. However perianal BCCs are seen lower then 1%. Conclusion: In general, diagnosed giant BCCs account for lower then 1% of all BCCs. One must keep in mind this diagnosis to discard the metastasis rate among BCCs.

The article describes the case of a 73-year-old male with giant basal cell carcinoma (GBCC). The patient arrived in the emergency department with a large bleeding ulcerated lesion of his right anterior chest wall and was in hemorrhagic and septic shock. His computed tomography of the chest revealed a subcutaneous defect with emphysema along the right axilla, sternal fracture and possible osteomyelitis. His treatment is primarily focused on excision and reconstruction.

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. [ABSTRACT FROM AUTHOR]

Skin cancer is the most reported malignancy in the world; its most common variant is basal cell carcinoma with a relatively benign behavior; however, giant basal cell carcinoma is a rare variant that is characterized by aggressive biological behavior with deep tissue invasion and increased metastatic capacity. The giant basal cell carcinoma is defined as greater than 5 cm in diameter, it is an infrequent variant (<1%) and its importance lies in its potential recurrence after extirpation (38%). We present the case of a 72-year-old Caucasian patient with the purpose of establishing the therapeutic options that adapt to the therapeutic resources of each institution. The follow-up sequence is presented, corroborating patient evolution, currently at 2 years free of disease. [ABSTRACT FROM AUTHOR]

Adenoid basal cell carcinoma (BCC) is a rare but aggressive histologic subtype of BCC. The aim of this report is to present our multidisciplinary management strategy and a literature review on this seldom reported entity. A 72-year-old female with fungating giant BCC of the scalp, ear, and bone underwent preoperative biopsy revealing adenoid histology with infiltrating and nodular components. The patient underwent radical resection of the biparietal and occipital scalp, auriculectomy and craniectomy with dural resection. Immediate reconstruction of the intracranial and bony defect was performed with dural substitute and a titanium cranioplasty. The soft tissue defect was reconstructed with a latissimus dorsi free flap and split thickness skin graft using the right superficial temporal artery and vein as recipient vessels. Adjuvant external beam radiation was initiated postoperatively. Nearly 2 years postoperatively, she presented mesh exposure necessitating secondary reconstruction with debridement, hardware removal, and an anterolateral thigh (ALT) free flap, followed by flap debulking. Four years following initial presentation, she remains disease-free. To our knowledge, this is the only reported case of a giant, locally invasive scalp BCC with the adenoid subtype treated with composite resection and single stage reconstruction. Using an aggressive multimodal management paradigm, treatment and surveillance of the rarely reported, giant, locally invasive scalp BCC with adenoid subtype can result in a durable disease-free response and a functional, esthetic reconstruction. Evidence-based medicine level. Level of Evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

The use of the topical Imiquimod 5% cream offers a noninvasive, nonsurgical, and an effective option for the treatment of primary small (5 cm) BCC with topical Imiquimod 5% cream are rare. We present our experience in the treatment of two giant tumors (6 × 8 cm 2 , 5.2 × 4.2 cm 2 ) of BCC on the face with Imiquimod 5% cream, 2 to 3 days/week for 12 weeks. Both the tumors were cured with clinical and pathological evidence, one with 6-year follow-up and the other with 3.5-year follow-up.

This case report describes a 59-year-old woman with a giant basal cell carcinoma on the face neglected for 11 years. Surgical resection of the lesion resulted in a 13 × 11 cm defect. Issues regarding the adequately safe surgical margins and the management of the resultant defect through modern wound dressing technologies are discussed.

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 ofpatient'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 occurringin 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.

There have been limited reported cases of pedunculated basal cell carcinoma(BCC). Our case is original, and it combines two rare aspects of CBC: Pedunculated and giant. This uncommon aspect is rarely encountered. [ABSTRACT FROM AUTHOR]

Objective: Although frequently regarded as a low grade malignancy, basal cell carcinoma (BCC) sometimes shows aggressive behavior. Giant BCC is defined as a lesion greater then 5 centimeter. Material and Methods: The authors described the diagnosis and treatment protocol of giant BCC, involving lumbosacral region without any local or distant metastasis. Also the authors went through a thorough a retrospective literature research of giant BCCs in terms of frequency and treatment. Results: Giant BCCs are biologically more aggressive; however, patient's negligence is a key factor for the tumor size. İnternational medical database (PubMed) search reveals 253 giant BCCs with the most commonly seen site as the face and back area. However perianal BCCs are seen lower then 1%. Conclusion: In general, diagnosed giant BCCs account for lower then 1% of all BCCs. One must keep in mind this diagnosis to discard the metastasis rate among BCCs. [ABSTRACT FROM AUTHOR]

Giant basal cell carcinomas (GBCCs) are large basal cell carcinomas (BCCs; <5 cm) with a greater propensity to invade and metastasize than standard BCCs. The presence of 2 GBCCs in a single individual is rare. We present the case of a 71-year-old Caucasian male with bilateral GBCCs on the dorsal forearms, measuring 130 cm² and 24 cm², respectively, that developed over a 21-year period. Over this period, the patient treated the tumors with herbal remedies. Histologic evaluation showed a conventional nodular BCC for both tumors. Computed tomography and magnetic resonance imaging revealed a T4N0M0 stage for the larger lesion. Surgical excision and grafting and reconstruction were offered, but he declined. This case highlights a shared belief in holistic treatments and rejection of Western medical inter-ventions that are common among many patients with GBCC. Studies reporting nonsurgical treatments for GBCCs, including radiotherapy, vismodegib, topical imiquimod, and acitretin are reviewed. [ABSTRACT FROM AUTHOR]

The use of the topical Imiquimod 5% cream offers a noninvasive, nonsurgical, and an effective option for the treatment of primary small (<2 cm) superficial basal cell carcinoma (sBCC). However, reports about successful treatment of giant (>5 cm) BCC with topical Imiquimod 5% cream are rare. We present our experience in the treatment of two giant tumors (6 × 8 cm2, 5.2 × 4.2 cm2) of BCC on the face with Imiquimod 5% cream, 2 to 3 days/week for 12 weeks. Both the tumors were cured with clinical and pathological evidence, one with 6-year follow-up and the other with 3.5-year follow-up. [ABSTRACT FROM AUTHOR]

Skin cancer is the most common malignant neoplasm worldwide and basal cell carcinoma is the most frequent type with a benign behavior, on the contrary, giant basal cell carcinoma is a rare subtype that is characterized by an aggressive biological behavior with involvement to deep tissue and its metastatic potential is reported to be high. This paper reports the case of a patient with myelodysplastic and myeloproliferative syndrome with an unresponsive giant basal cell carcinoma that was excised by extensive surgery with a multidisciplinary team. In a second operation, reconstructive surgery was performed using a vascularized composite graft with functional preservation of the affected area. [ABSTRACT FROM AUTHOR]

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Basal cell carcinoma (BCC) is the most frequent histological type of cancer in the world and accounts for approximately 80% of all skin cancers.In the majority of cases, they are slow-growing, low metastatic potential tumors, easy to cure by surgical or nonsurgical procedures.Giant BCC (GBCC) is a rare variant of BCC and according to the American Joint Committee on Cancer, this includes lesions with a diameter larger than 5 cm.GBCC's incidence has been reported to be less than 1%, and it displays a more aggressive behavior with both local invasion and higher metastatic potential.Archodaki et al.specifically reported that metastasis was present in 17.6% of GBCC patients during the primary examination. Patients with GBCC who are not suitable for either surgery or radiotherapy since 2012 seem to have another therapeutic option. Vismodegib is an oral small-molecule inhibitor of the Hedgehog pathway (HPI) that was approved for treating metastatic or locally advanced BCC in patients who are poor candidates for surgery or radiotherapy.In this case, we present a woman with two simultaneous facial GBCCs who was treated successfully using vismodegib as a monotherapy. [ABSTRACT FROM AUTHOR]

Anterior chest wall Giant Basal Cell Carcinoma (GBCC) is rare amongst GBCC cases and results in a large defect that is challenging to resect and reconstruct. It requires multidisciplinary approach to prevent recurrence. A 72-year-old man with giant basal cell carcinoma at the anterior chest wall measuring 10 × 6 cm. Wide resection of 1 cm margin with axial flap was performed to close the defect. The follow-up report stated that the patient was satisfied with the result and there was no recurrence observed. Review of literatures concludes that GBCC is excised with a minimum of 4-6 mm margin outside the tumor area. The axial IMAP flap is ideal to close the upper chest wall defect because of the better aesthetic outcome compared to other conventional flaps, especially in stable elderly male, patients with noninfected wound. Increased skin laxity and more relaxed skin tension associated with aging allows easier tissue mobilization and transfer to close the defect. Axial flap for GBCC in anterior chest wall is ideal, safe, and has the advantage of aesthetic reasons of suitable skin tone, particularly for stable elderly male patients. • A 72-year-old man presented with a seven-year history of ulcerating mass on his anterior chest wall. • Histopathologic examination confirmed the diagnosis of giant basal cell carcinoma (GBCC). • We performed wide resection with 1 cm margin and reconstruct the defect with axial flap. • No evidence of recurrence observed after 1 year of resection. [ABSTRACT FROM AUTHOR]

Basal cell carcinomas are the most common malignancy in Caucasian populations with a very low predisposition to metastatic disease and an excellent prognosis if appropriately treated. Given the rarity of a lethal outcome two cases are reported. Case 1 : A 61-year-old reclusive man who had an untreated facial basal cell carcinoma for 10 years died of hypothermia and sepsis complicating the extensively ulcerated and infected tumour. He also had underlying cardiomegaly, ischaemic heart disease and chronic obstructive pulmonary disease. Case 2 : A 60-year-old man who had an untreated lower lumbar basal cell carcinoma for 14 years died of sepsis, inanition and pulmonary thromboembolism (due to a right-sided deep venous thrombosis) complicating the deeply ulcerated tumour. Untreated giant basal cell carcinoma may uncommonly present for medicolegal assessment with complex pathophysiological lethal mechanisms. The possibility of Diogenes syndrome should be considered.

Although basal cell carcinoma (BCC) is the most common form of skin cancer, the scalp lesions of BCC have been rarely reported. Giant BCC is defined as a tumor larger than 5 cm in diameter and only 0.5-1 % of all BCCs achieve this size. We report a case of giant BCC on the scalp that was treated with topical coticosteroids and antifungal shampoo for five years. BCC should be considered in the differential diagnosis in erythematous plaque type lesions resistant to therapy with long duration localized on the scalp. [ABSTRACT FROM AUTHOR]

Abstract Basal cell carcinomas may attain giant proportions due primarily to recurrence or because the tumour is neglected. We report the case of a 66-year-old man who presented with a bleeding, polypoid, cutaneous tumour located on the left shoulder region of 13 years duration. The man had not received any previous treatment. The lesion was biopsied and histopathologically diagnosed as a solid type basal cell carcinoma with focal areas of squamous differentiation and keratinization. The man refused complete surgical removal and therefore was treated with roentgentherapy, with satisfactory results and no complications in the irradiated area. No recurrences had manifested after 1 year follow-up. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma (BCC) is the most prevalent malignancy, with rising incidence worldwide. Despite its naturally slow growth and initially low metastatic potential, it can cause significant morbidity and mortality when unrecognized, inadequately treated or poorly followed up. Authors present the case of a 61-year-old male with a 7-year history of multiple incomplete excisions of a &#8220;simple&#8221; BCC on the forehead. A CT scan of the head revealed an invasive mass (5.2 cm laterolateral x 4.0 cm craniocaudal) in the frontal area. There was no evidence of metastasis. Complete resection of the lesion and reconstruction was achieved in three stages. Final reconstruction was achieved using a left frontal fasciocutaneous flap. The secondary defect was closed with an advancement flap of the scalp and donor sites were covered using a split-thickness skin graft from the upper limb. This case demonstrates the necessity for vigilance in the approach to, diagnosis, treatment and follow-up of these skin neoplasms. The development of giant BCCs should be avoided at all costs. Increased size of BCCs corresponds with increased recurrence rate, metastatic rate, morbidity, mortality, treatment difficulties and overall costs.