Giant Basal Cell Carcinoma: Causes, Symptoms, Treatment, and Prevention

Giant Basal Cell Carcinoma: Causes, Symptoms, and Treatment

Basal cell carcinoma (BCC) is the most common form of skin cancer. This slow-growing cancer usually appears as a small, shiny bump on sun-exposed areas like the head and neck. But in rare cases, neglected BCCs can reach massive sizes.

This article explores giant basal cell carcinomas, including:

• What defines a giant basal cell carcinoma
• Underlying causes and risk factors
• Typical symptoms
• Diagnostic tests
• Treatment options
• Outlook and prognosis
• Prevention

Let's start with what makes a BCC "giant."

What is a Giant Basal Cell Carcinoma?

Most basal cell carcinomas are caught early when they measure less than 2 centimeters wide. But some grow undiagnosed over months and years into massive tumors.

Giant basal cell carcinomas are loosely defined as BCCs exceeding 5 centimeters in diameter. However, some authors use a 10 centimeter cut-off.

These sizable skin cancers develop slowly. They often first appear on the head, neck, or back and are frequently ignored by patients.

As they expand, giant BCCs burrow deeper below the skin surface. Without treatment, they can invade into fat, muscle, cartilage, and bone.

Causes and Risk Factors

All BCCs, including giant ones, are primarily triggered by ultraviolet rays from sunlight or tanning beds. People with the following are most prone to developing giant basal cell carcinomas:

• Lifetime of heavy sun exposure
• Previous BCCs or skin cancer
• Light hair and skin tone
• Advanced age
• Long-term tanning bed use
• Severe childhood sunburns
• Genetic syndromes like nevoid BCC syndrome and xeroderma pigmentosum
• Immunosuppression drugs after an organ transplant

The repeated DNA damage from UV radiation causes mutations in skin cells. When these mutations affect tumor suppressor genes, it can trigger basal cell cancers.

Symptoms of Giant Basal Cell Carcinoma

Giant basal cell carcinomas exhibit several distinctive traits:

• Pearly, smooth appearance
• Shiny, waxy surface
• Visible blood vessels
• Oozing sores and crusting
• Raised pinkish edges with central depression
• Growth larger than 5 cm
• Exist for months to years before diagnosis
• Located on the head, neck, or back

Some also develop an unpleasant odor and bleed easily when irritated. Compared to other skin cancers, giant BCCs rarely metastasize or spread internally.

Still, their substantial size can lead to disfigurement as they invade surrounding tissues. Catching them early is key.

Diagnosing Giant Basal Cell Carcinomas

To diagnose a suspected giant basal cell carcinoma, a dermatologist will:

• Visually inspect the growth and take a biopsy
• Use a dermatoscope to examine under the surface at 10x magnification
• Perform a histopathology exam on the biopsy tissue
• Order imaging tests to see depth of invasion

Under a microscope, BCC cells have a characteristic appearance. Histology helps distinguish BCCs from benign cysts or other skin cancers.

For sizable growths, CT scans, MRI, and ultrasonography can reveal if the cancer has spread into cartilage, bone, or other structures.

Treatment Options

Several treatments can be used to remove giant basal cell carcinomas and minimize scarring:

Surgical Excision

Cutting away the entire cancerous lesion with a margin of healthy tissue. This is the standard treatment for giant BCCs.

Mohs Micrographic Surgery

Removing skin layer by layer while examining margins. This spares the most healthy tissue and has the highest cure rate.

Cryosurgery

Freezing and destroying abnormal cells with liquid nitrogen. May be used alongside curettage (scooping out tissue).

Radiation Therapy

Using targeted x-ray beams on lesions when surgery is not possible. This gradually shrinks the tumor.

Photodynamic Therapy

Applying a light-sensitizing medication and activating it with a special laser light. Often used for superficial BCCs.

Topical Medications

Applying imiquimod or 5-fluorouracil creams, which stimulate an immune response against tumor cells.

With early detection, most giant basal cell carcinomas can be successfully treated and removed. Reconstructive surgery may be needed to heal wounds or repair deformities.

Outlook and Prognosis

If adequately excised, the prognosis is generally good even for giant basal cell carcinomas. Recurrence rates are under 10% with Mohs surgery.

However, neglected tumors that penetrate deeply into facial bones, cartilage, and nerves can be disfiguring and even fatal in extremely rare cases.

Metastasis to other body parts is highly unusual. But large neglected BCCs may invade the skull and brain, requiring extensive surgery.

That's why it's critical to have any suspicious growths checked promptly by a dermatologist before they become giant carcinomas.

Preventing Giant Basal Cell Carcinomas

You can reduce the likelihood of developing giant basal cell carcinomas through preventive measures:

• Apply broad-spectrum SPF 30+ sunscreen daily
• Limit direct sun exposure, especially 10am to 4pm
• Wear protective clothing like hats and UV blocking clothing
• Don't use tanning beds
• Examine skin monthly and note changes in moles or spots
• Get annual skin checks by a dermatologist
• Treat any actinic keratoses promptly as they can develop into skin cancers

Detecting BCCs early when they are small and thin is crucial. So be vigilant about sun protection and speak to a dermatologist if you notice any odd growths.

The Takeaway

Giant basal cell carcinomas over 5 centimeters wide develop from neglected, longstanding tumors. They can invade deep into tissues, destroying cartilage, bone, and nerves in severe cases.

Surgical excision and Mohs surgery successfully remove giant BCCs in most patients. But avoiding disfigurement or metastasis requires early detection.

Protect your skin from the sun, do self-exams, and promptly treat actinic keratoses and small lesions. Being proactive helps prevent tiny BCCs from ever progressing to giants.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.