Fatal outcome in a metatypical, giant, "horrifying" basal cell carcinoma

Mutilating, horrifying, aggressive basal cell carcinoma (BCC) is a rare cutaneous neoplasm. We report a case of mutilating BCC of the face and its peculiar histologic features. The primary lesion, before therapy, demonstrated typical BCC in association with lobules of metatypical cells. The recurrent BCC, after radiation therapy, had a metatypical pattern. We believe that the metatypical BCC is a potentially aggressive lesion. It is essential for this tumor to be recognized early and treated surgically.