Sequential treatment of giant basal cell carcinomas

Treatment of giant basal cell carcinomas (GBCC) can pose several challenges. In such instances, use of routine and recommended treatments for sporadic, average size basal cell carcinomas (BCC) is suboptimal, impractical and often leads to treatment failure. Surgical excision of such large lesions results in marked intra and postoperative morbidity. While individually, photodynamic therapy, topical imiquimod and surgical excision are all established treatments for BCC, their combined use in the treatment of GBCC has not been explored. Three patients with histologically proven GBCC were sequentially treated with three cycles of metvix photodynamic therapy followed by a 6-week course of topical imiquimod. This led to a reduction in the size of these lesions which were subsequently excised.