Reappraisal of giant basal cell carcinoma: clinical features and outcomes

Abstract Background Giant basal cell carcinoma (GBCC) is a rare subgroup of basal cell carcinomas with diameter >5cm. Current evidence about determining factors is conflicting, suggesting patient neglect on one hand, and biologically aggressive behavior on the other, with outcomes varying from clearance to death. We aimed to clarify the natural history of GBCC and its response to treatment. Methods We extracted information from clinical records of all patients with GBCC treated 1998 to 2017 in a tertiary oncology hospital in northwest England. Associations between patient and tumour characteristics were investigated, and modes of treatment and outcomes were assessed. Results In the 20-year study period, 43 patients (median age 76 years; 23 (53%) female), 3 of whom had Gorlin syndrome, were treated for GBCCs. Median diameter was 6.3cm and median time to presentation was 5 years. Seven (16%) GBCCs arose from recurrent BCC while the majority (84%) presented de novo. Size of GBCC was significantly correlated with delay in presentation (p=0.03) but not with age or sex. Of 41 patients receiving definitive treatment, 19 GBCCs were treated by excision with ≤1cm margins and none recurred during follow up, compared with 10 recurrences of 23 treated with photodynamic therapy (PDT), and 1 of 7 recurred after radiotherapy. Two of 43 GBCC patients ( Conclusion The majority of GBCCs are not clinically aggressive and respond to conservative surgical treatment with low risk of recurrence.