By Gary M. White, MD
If left for years, a basal cell carcinoma (BCC) may become quite large. Metastasis is still relatively uncommon, but may occur. The term "locally advanced BCC" has been used for these large BCCs that present a treatment challenge and may potentially metastasize. It has been estimated several thousand people die each year in the US from BCC. Unfortunately, patients with these neglected skin carcinomas commonly have been seen by multiple physicians and received a long list of topical medications before reaching the right diagnosis [JEADV 2016;30;367].
Large BCCs on the trunk may be surgically excised of course, but if technically difficult, radiation therapy may be employed. Odomzo and Erivedge (vismodegib) are FDA-approved for many of these locally advanced BCCs. Short-term, preoperative vismodegib for 3 months for BCC reduced the surgical defect by 31% in one study [JAAD 2014;71:904-11]. Rarely, traditional chemotherapy may be considered.
Topical imiquimod has been used.
An 8 x 6 cm biopsy-proven BCC on the hip of an older woman. This lesion was treated with radiation therapy.
Large BCC in the axilla, an unusual place. Surgical excision worked fine here.
Large, friable, bleeding BCC of the shoulder. Surgical excision worked here as well, but resulted in a large scar.
Large lesion on the forehead.
Large, superficial, and recurrent after an ill-conceived C&D.
Three centimeter BCC on the shin in the setting of venous stasis. Challenging treatment-wise. Referral to a plastic surgeon was made.
Topical imiquimod for a large BCC. A 51-year-old man treated a large BCC of the cheek with topical imiquimod 5% cream every other night for a total of 12 weeks. The after picture is 4 years later. Indian J Dermatol 2014;59:575-8
Metastatic basal cell carcinoma to the lungs: Case report and review of literature. Indian Dermatol Online J 2014;5, Suppl S1:26-9
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