Giant Ulcerative Basal Cell Carcinoma with Local Metastasis: A Case Report and Assessment of Surgical Techniques

Giant basal cell carcinoma (GBCC) is a rare skin cancer characterized by an aggressive biological behavior with extensive local invasion, frequent metastasis, and associated poor prognosis. Wide local excision with sentinel lymph node biopsy is often warranted for this condition, and reconstruction by local rotational flap is one of the best surgical techniques for repairing similar skin cancers with a relatively large skin defect. A 59-year-old man who was a former construction worker with a significant smoking history presented with a single giant suspicious chronic ulcerating skin lesion measuring 9 x 7 cm that proved to be a basal cell carcinoma (BCC) on his left shoulder. The patient was negative for enlarged or palpable lymph nodes and underwent a wide local excision and primary repair with a local flap. Despite negative margins, his follow-up visits at six, nine, and 10 months revealed numerous suspicious lesions that further required multiple local wide excisions that showed new basal cell carcinoma and recurrence to the left axilla. Given the invasiveness of his skin cancer, he was referred to oncology and later treated by chemoradiation. Patients with multiple risk factors are associated with a higher incidence of more invasive skin cancer due to possible cumulative effects. The therapeutic approach for GBCC should involve multidisciplinary teams, with wide local resection of the tumor with possible sentinel lymph node biopsy, local rotational flap for reconstruction of the wide defect, and adjuvant chemoradiotherapy if necessary.