Okano Junko, Arata Jun, Arakawa Atsuhiro, Ogino Shuichi, Yamashita Teruyo
Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Shiga, Japan.
Plast Reconstr Surg Glob Open. 2023 Feb 2;11(2):e4812. doi: 10.1097/GOX.0000000000004812. eCollection 2023 Feb.
Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers.
基底细胞癌（BCC）在临床环境中相对容易诊断，是皮肤中最常见的恶性肿瘤。相反，巨大基底细胞癌，即直径超过5厘米的肿瘤，是一种罕见疾病。特别是直径超过20厘米的巨大基底细胞癌被称为超级巨大基底细胞癌，它经常侵犯更深层的组织，包括真皮、骨骼或肌肉。在此，我们报告一例71岁患者，最初被诊断为头部多处创伤伴大的骨膜缺损。溃疡被恶臭的坏死组织和腐肉包围，检测到几种导致坏死性筋膜炎的细菌。广泛清创后的定位活检显示为基底细胞癌，因此，他最终被诊断为超级巨大基底细胞癌。仔细询问发现大约10年前头部受伤后头部有溃疡病史。他接受了包括颅骨外板的根治性切除术，随后进行了带网状分层皮片移植的背阔肌游离皮瓣移植术。由于超级巨大基底细胞癌发展缓慢且呈慢性，准确诊断往往困难。对于长期存在溃疡的患者应予以密切关注。
