Aggressive progression of a facial super giant basal cell carcinoma

Super giant basal cell carcinoma (BCC) is a rare oncological entity. A 52-year-old man with a history of a left upper facial lesion for 11 years was transferred to our facility seeking an evaluation. He frequented multiple hospitals where he was treated with antibiotics for this condition. He reported having the Mohs procedure 8 months prior to this hospital visit but he did not follow-up with the other institution. The physical examination revealed an ulcer involving the upper left orbito-fronto-parieto-temporal area with bone exposure. Both CT and MRI of the face and the brain demonstrated dehiscence of the left lateral orbital roof and left frontal bone. The biopsy confirmed advanced BCC. He was discharged against medical advice and lost to follow-up. He returned 1 month later with left eye discharge and vision loss. He was diagnosed with cerebral abscess, treated with antibiotics and discharged to hospice.