Neglected cutaneous skin malignancy: A patient with concurrent giant basal cell carcinoma and melanoma

Giant basal cell carcinomas (BCCs) are a rare subtype of BCC that grow to be greater than 5 cm in diameter. With the increase in size, there is a corresponding increase in metastatic rate and state of local invasion, with a clinical morphology that can be hard to differentiate from other subtypes of cutaneous malignancy. Although histologically equivalent to their common sub-centimetre counterparts, giant BCCs can precipitate significant systematic medical morbidity as well as psychological trauma, and can be a real surgical reconstructive challenge to clinicians.

To add breadth to the existing cases in the literature, as well as a fresh patient perspective on the psychological challenges in a patient with Giant BCC.

A case from the Waikato Hospital, New Zealand referred to the Plastic and Reconstructive Department is carefully photographed, ordered, and presented.

We present a case of a 15 cm giant BCC of the back existing alongside a neglected thick exophytic melanoma of the elbow in a patient who had been too embarrassed to approach healthcare professionals. These skin lesions were an incidental discovery by the general practitioner after the patient presented with symptoms of shortness of breath.

Neglected skin cancers can fungate and be clinically morphologically confusing. Photographs of examples of these tumours can hone clinician awareness of the existance of Giant BCCs.

Giant BCCs are an entity yet to receive standardized treatment stratification. Prompt diagnosis and staging scans mean an expedited path to wide local excision and reconstruction, resulting in timely resolution of patients' immediate morbidity from their oncological disease burden.