Giant Basal Cell Carcinoma of the Axilla: 8-year Follow-up of a Case Treated with Excision, Vismodegib, and Radiotherapy

May 2022 | Volume 21 | Issue 5 | 531 | Copyright © May 2022


Published online April 22, 2022

Shih-Chiang Kuo MD, Yao-Chou Lee MD

Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Abstract
Axillary giant basal cell carcinoma is extremely rare and remains challenging for physicians. The few reported cases have a relatively short-term follow-up, and none were treated with an oral hedgehog pathway inhibitor. Herein, we report the case of a 71-year-old man with a giant basal cell carcinoma in the axilla. The primary treatment instituted was surgical excision and adjuvant radiotherapy. The tumor recurred 4.5 years later, and 6-month treatment with vismodegib, a hedgehog pathway inhibitor, was effective. The disease progression re-occurred 1.5 years after discontinuing vismodegib. Palliative radiotherapy was administered, and the disease remained stable for > 1 year. Our case illustrates a rare disease with an 8-year follow-up, involving different therapeutic strategies against multiple recurrences.

J Drugs Dermatol. 2022;21(5):531-533. doi:10.36849/JDD.6583

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.

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