Exploration Into Super-Giant Basal Cell Carcinoma Calls for Future Research

Super-giant basal cell carcinoma (SGBCC) is a rare and understudied form of skin cancer that behaves distinctly from basal cell carcinoma (BCC); according to a recent systematic review published in Annals of Medicine & Surgery, more research is needed to better characterize this form of skin cancer.¹

Sign Reading Basal Cell Carcinoma | image credit: Yurii Kibalnik - stock.adobe.com

An SGBCC lesion is extremely rare and classified by a large diameter, which spans more than 20 cm. Comparatively, giant BCC (GBCC) tumors are identified by a diameter that surpasses 5 cm. While BCCs are among the most common and easily diagnosable skin lesions, neglected tumors can grow gradually and slowly invade deeper into a patient’s dermis, muscles, or bones.²

According to Okano et al, who reported on a misdiagnosed case of SGBCC,² this chronic, gradual expansion is part of what makes an accurate diagnosis of SGBCC so challenging. In their case study, an elderly man was thought to have suffered multiple traumas before further consultations revealed an SGBCC covering his cranium. This patient had presented with multiple injuries, namely an ulcer that stemmed from a head injury 10 years prior. The ulcer, coinciding with a plethora of slough, necrotic tissue, and bacteria, made the underlying presence of an SGBCC difficult to detect during the initial examination.²

Accurate and early diagnosis of an SGBCC is of great importance, as the authors of the present study pointed out, because it is known as a very aggressive form of disease.¹

The literature regarding SGBCC is considerably lacking, despite BCC being the most prevalent skin malignancy across some populations, the authors noted. To expand on existing knowledge, they conducted a comprehensive review of SGBCC literature with an aim of better characterizing the disease, affected populations, risks, and other factors.

Beginning on September 17, 2023, data were collected from Google Scholar, PubMed, Medline Ultimate, and the Cumulative Index to Nursing and Allied Health Literature. With the use of relevant search terms, studies spanning between 1972-2023 that focused on SGBCC were reviewed.

The analysis revealed 9 cases that occurred in North America, 7 in Europe, and 4 in Asia over the last 50 years. Affected patients ranged from ages 43-73 with an average age of 61. Thirteen of the SGBCCs were in male patients and 7 in female patients. In 16 of the 20 cases, lesions were localized to the trunk area, with the remaining SGBCCs occurring on the head (n = 3) and an extremity (n = 1). Metastasized SGBCC was found in 7 patients. Lesions endured for over 10 years in 13 patients, and less than 10 years in 5 patients. Additionally, throughout the 20 cases, chemotherapy was used in 1 case, immunotherapy in 4, radiation in 6 cases. Surgery was performed in 11 patients, whereas 4 did not receive any treatment.

The authors noted that, unlike BCCs, which generally occur in areas of the head or neck that are exposed to the sun, SGBCCs typically arise in clothing-covered areas. They are able to expand so exponentially, the authors added, due to neglect by the patient.

Their analysis further revealed that the 20 occurrences of SGBCC over the last 50 years were associated with individuals of lower socioeconomic statuses. In this realm, the authors commented that various disabilities (mental and physical) could get in the way of someone’s ability to access the health care system, thus increasing the chances that a tumor goes unnoticed.

“Although only 0.03% of BCCs are found to have metastases, it has been estimated that BCCs larger than 5 and 10 cm in diameter are associated with chances of metastases or death of ~25 and 50%, respectively,” the authors wrote. They added that associated complications with bigger BCCs, such as severe anemia, sepsis, or infection, increase a patient’s risk of morbidity or death even in the absence of metastasis.

“We propose that actual incidence of this entity is higher than the published data. Large cohort, multicenter studies may be needed to further characterize SGBCC. We also believe there is an opportunity to educate and integrate mental health providers and social workers as part of the care team to address the social and economic conditions impacting this diagnosis,” the authors concluded.

References

1. Kang AS, Kang G, Kathuria HS. Super giant basal cell carcinoma: A comprehensive systematic review. Ann Med Surg (Lond). 2024;86(5):2935-2939. doi:10.1097/MS9.0000000000001958

2. Okano J, Arata J, Arakawa A, Ogino S, Yamashita T. A case of super-giant basal cell carcinoma initially diagnosed as multiple traumas. Plast Reconstr Surg Glob Open. 2023 Feb 2;11(2):e4812. doi:10.1097/GOX.0000000000004812