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Neglected Basal cell carcinomas in the 21st century.

Varga E, Korom I, Raskó Z, Kis E, Varga J, Oláh J, Kemény L - J Skin Cancer (2010)

Bottom Line: The therapy of neglected cases demands an individual multidisciplinary approach and teamwork.Basal cell carcinoma (BCC), the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential; these factors are suggesting that BCCs might well be the "ideal candidates" for neglected tumors.Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary.

ABSTRACT
Although tumors on the surface of the skin are considered to be easily recognizable, neglected advanced skin neoplasms are encountered even in the 21st century. There can be numerous causes of the delay in the diagnosis: fear of the diagnosis and the treatment, becoming accustomed to a slowly growing tumor, old age, a low social milieu, and an inadequate hygienic culture are among the factors leading some people not to seek medical advice. The treatment of such advanced neoplasms is usually challenging. The therapy of neglected cases demands an individual multidisciplinary approach and teamwork. Basal cell carcinoma (BCC), the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential; these factors are suggesting that BCCs might well be the "ideal candidates" for neglected tumors. Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009. The clinical characteristics and treatment modalities of these neoplasms are discussed, together with the possible causes of the neglect.

No MeSH data available.


Related in: MedlinePlus

Case 1: A mutilating tumor on the right side of the patient's face.
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Related In: Results  -  Collection


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fig1: Case 1: A mutilating tumor on the right side of the patient's face.

Mentions: When a 44-year-old male first sought for medical advice in December 2009, he had already had a mutilating, horrifying tumor on the right side of his face for 10 months. He lived alone in a farmhouse in a rural, but quite densely populated area. Two years previously, his own dog had clawed on the right side of the patient's nose, with the injury leaving a scar. Eleven months before his presentation, he had suffered another minor injury in the same region caused by a splinter of wood. A gradually growing, ulcerating lesion had subsequently developed on his face (Figure 1). The clinical diagnosis was BCC, but the possibility of Wegener's granulomatosis also emerged together with a suspicion of leprosy or some other bacterial infection. The CT scan revealed an extensive bone defect: the maxillary sinus had perished, half of the nasal bone and the zygomatic arch were missing, and the external wall of the frontal sinus was involved. As three types of bacteria were identified, intravenous antibiotic treatment was started. Multiple biopsies confirmed the presence of BCC (Figure 2). The tumor was resected at the Oral and Maxillofacial Surgery Department and the defect was covered with a frontotemporal rotation flap and a latissimus dorsi musculocutaneous free flap. In the postoperative period, the patient suffered a right-sided temporal lobe emollition of the brain, resulting in left-sided hemiplegia. The skin layer of the flap necrotized, but the muscular layer remained intact, and healed by secondary epithelialization. After 6 months, recurrences around the mouth necessitated repeated excisions with a forearm fascio-cutaneous free flap reconstruction. This flap necrotized in full thickness and it had to be removed, and the defect was closed in a direct manner. The patient is now tumor-free, but his face has not been reconstructed functionally or esthetically (Figure 3). His nutrition is solved, and physiotherapy has led to a significant improvement in his extremity movements: he can walk alone and use his left hand.


Neglected Basal cell carcinomas in the 21st century.

Varga E, Korom I, Raskó Z, Kis E, Varga J, Oláh J, Kemény L - J Skin Cancer (2010)

Case 1: A mutilating tumor on the right side of the patient's face.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2993023&req=5

fig1: Case 1: A mutilating tumor on the right side of the patient's face.
Mentions: When a 44-year-old male first sought for medical advice in December 2009, he had already had a mutilating, horrifying tumor on the right side of his face for 10 months. He lived alone in a farmhouse in a rural, but quite densely populated area. Two years previously, his own dog had clawed on the right side of the patient's nose, with the injury leaving a scar. Eleven months before his presentation, he had suffered another minor injury in the same region caused by a splinter of wood. A gradually growing, ulcerating lesion had subsequently developed on his face (Figure 1). The clinical diagnosis was BCC, but the possibility of Wegener's granulomatosis also emerged together with a suspicion of leprosy or some other bacterial infection. The CT scan revealed an extensive bone defect: the maxillary sinus had perished, half of the nasal bone and the zygomatic arch were missing, and the external wall of the frontal sinus was involved. As three types of bacteria were identified, intravenous antibiotic treatment was started. Multiple biopsies confirmed the presence of BCC (Figure 2). The tumor was resected at the Oral and Maxillofacial Surgery Department and the defect was covered with a frontotemporal rotation flap and a latissimus dorsi musculocutaneous free flap. In the postoperative period, the patient suffered a right-sided temporal lobe emollition of the brain, resulting in left-sided hemiplegia. The skin layer of the flap necrotized, but the muscular layer remained intact, and healed by secondary epithelialization. After 6 months, recurrences around the mouth necessitated repeated excisions with a forearm fascio-cutaneous free flap reconstruction. This flap necrotized in full thickness and it had to be removed, and the defect was closed in a direct manner. The patient is now tumor-free, but his face has not been reconstructed functionally or esthetically (Figure 3). His nutrition is solved, and physiotherapy has led to a significant improvement in his extremity movements: he can walk alone and use his left hand.

Bottom Line: The therapy of neglected cases demands an individual multidisciplinary approach and teamwork.Basal cell carcinoma (BCC), the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential; these factors are suggesting that BCCs might well be the "ideal candidates" for neglected tumors.Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary.

ABSTRACT
Although tumors on the surface of the skin are considered to be easily recognizable, neglected advanced skin neoplasms are encountered even in the 21st century. There can be numerous causes of the delay in the diagnosis: fear of the diagnosis and the treatment, becoming accustomed to a slowly growing tumor, old age, a low social milieu, and an inadequate hygienic culture are among the factors leading some people not to seek medical advice. The treatment of such advanced neoplasms is usually challenging. The therapy of neglected cases demands an individual multidisciplinary approach and teamwork. Basal cell carcinoma (BCC), the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential; these factors are suggesting that BCCs might well be the "ideal candidates" for neglected tumors. Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009. The clinical characteristics and treatment modalities of these neoplasms are discussed, together with the possible causes of the neglect.

No MeSH data available.


Related in: MedlinePlus