Basal Cell Carcinoma in a Childhood Cancer Survivor: What Neurosurgeons Should Avoid

Among childhood cancer survivors (CCSs), non-melanoma skin cancer (NMSC) is the most common type of second malignancy. Morbidity related to the development of NMSC in this group of patients may be sometimes unpredictable and difficult to manage. We present the case of a 49-year-old female who was a CCS and developed giant superficial basal cell carcinomas (sBCCs) over the previously irradiated field of the scalp. BCC involved the atrophic skin overlying the catheter of the peritoneal cerebral shunt that was set there for the management of hydrocephalus. Topical treatment with imiquimod 5% resulted in local skin reaction that was further complicated with catheter exposure. The patient underwent an emergency neurosurgery for reposition of the cerebral shunt. Subsequent treatment with imiquimod resulted in complete resolution of sBCC. Given the increased risk for the development of BCCs in CCSs, awareness of neurosurgeons is crucial. Avoidance of setting the catheter of the cerebral shunt within the radiotherapy field is highly recommended, in order to avoid unnecessary future surgeries and subsequent morbidity, as in our case.