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Metastatic insidious super giant basal cell carcinoma
  1. Maryam Ahmed,
  2. Tinatin Muradashvili,
  3. Sara Soliman and
  4. Medhat Ghaly
  1. Yale-Waterbury Internal Medicine Residency, Yale University School of Medicine, Waterbury, Connecticut, USA
  1. Correspondence to Dr Medhat Ghaly; medhat.abdelmessih{at}


A middle-aged woman presented with a mechanical fall. Physical examination revealed a massive purulent ulcerated lesion spanning her entire back and axilla, which had reportedly been brewing for over a decade. Punch biopsy revealed infiltrative basal cell carcinoma. She was treated with Vismodegib, with a remarkable decrease in the size of the cancer. However, surveillance imaging after 6 months of treatment revealed new bone metastases. In the setting of progressive disease, medical therapy was switched to cemiplimab instead. Basal cell carcinoma is commonly known as a benign tumour of the skin, rarely larger than 5 cm. Here, we discuss the entity of metastatic super giant basal cell carcinoma; this case is one of the largest reported lesions. As locoregional therapy, such as surgery is sometimes not appropriate for such advanced lesions, we discuss the current forefront of therapy including oral hedgehog pathway and check point inhibitors.

  • Cancer intervention
  • Immunology
  • Skin cancer
  • Depressive disorder
  • Surgical oncology

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  • Contributors MA, SS, and TM developed the original idea, reviewed literature data, prepared the manuscript, and provided additional review. MG contributed to major areas of the manuscript and provided a revision of the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.