INTRODUCTION
Giant basal cell carcinoma (GBCC), a tumor >5 cm in diameter, is a rare subgroup of basal cell carcinoma (BCC) comprising < 1% of all cases.1 Typically, GBCC is associated with a long mean duration of tumor evolution from 8 to 14.57 years and a greater frequency of high-grade histological subtypes.2,3 Furthermore, conflicting results have been reported regarding local recurrence or metastasis.1,3,4
There are very few case reports of axillary GBCC, and only three reports included detailed clinical descriptions.5-7 Of note, all these cases were reported before the introduction of oral hedgehog pathway inhibitors as a treatment option. Herein, we present a case of axillary GBCC with an 8-year follow-up, treated with surgical excision and adjuvant radiotherapy, salvaged with oral hedgehog pathway inhibitor, and palliative radiotherapy for local recurrences.
There are very few case reports of axillary GBCC, and only three reports included detailed clinical descriptions.5-7 Of note, all these cases were reported before the introduction of oral hedgehog pathway inhibitors as a treatment option. Herein, we present a case of axillary GBCC with an 8-year follow-up, treated with surgical excision and adjuvant radiotherapy, salvaged with oral hedgehog pathway inhibitor, and palliative radiotherapy for local recurrences.
CASE REPORT
Primary Treatment: Surgical Excision and Adjuvant Radiotherapy
In April 2013, a 71-year-old man presented with a 15 × 12 cm cutaneous ulcer over his right axilla (Figure 1A), which had been noticed for 20 years but was neglected, and no treatment was sought. He came for medical advice because it continued to enlarge, and active bleeding was noticed recently. Chest computed tomography revealed an ulcerative lesion in the axilla with enlarged lymph nodes and probable vascular invasion (Figure 1B). Skin biopsy showed infiltrating nests of atypical, hyperchromatic basaloid cells with peripheral palisading of the nuclei; based on these characteristics, BCC was diagnosed (Figure 1C). Ber EP4 staining of the neoplastic cells was positive, consistent with the features of BCC (Figure 1D). The tumor was
In April 2013, a 71-year-old man presented with a 15 × 12 cm cutaneous ulcer over his right axilla (Figure 1A), which had been noticed for 20 years but was neglected, and no treatment was sought. He came for medical advice because it continued to enlarge, and active bleeding was noticed recently. Chest computed tomography revealed an ulcerative lesion in the axilla with enlarged lymph nodes and probable vascular invasion (Figure 1B). Skin biopsy showed infiltrating nests of atypical, hyperchromatic basaloid cells with peripheral palisading of the nuclei; based on these characteristics, BCC was diagnosed (Figure 1C). Ber EP4 staining of the neoplastic cells was positive, consistent with the features of BCC (Figure 1D). The tumor was
