Giant anterior chest wall basal cell carcinoma: a reconstructive challenge and review of the literature

Abstract

Giant basal cell carcinomas (GBCC) are rare, accounting for <1% of BCCs. Those occurring on the anterior chest wall are a very rare subset that brings particular reconstructive challenges. We describe a 75-year-old man whose 13.5 cm diameter ulcerating GBCC on his left anterior chest came to medical attention following a fall. The lesion was resected en-bloc with adjacent ribs, and reconstructed with an omental flap, superiorly pedicled vertical rectus abdominus myocutaneous (VRAM) flap and split skin grafting. While the myriad reasons for delayed presentation of giant cutaneous malignancies are well documented, the complex nature of reconstruction and requirement for an integrated multidisciplinary approach are less so. It is of importance to note that the cicatricial nature of these lesions may result in a much larger defect requiring reconstruction than appreciated prior to resection. Documented cases of anterior chest wall GBCC and the treatment strategies employed are reviewed.

Figure 1

Giant chest wall  basal cell carcinoma at initial presentation.

Figure 2

(A) Extent of the defect requiring reconstruction following excision; (B) excision specimen (posterior view).

Figure 3

Immediate postoperative appearance of pedicled vertical rectus abdominus myocutaneous and split skin grafting to omental flap.

Figure 4

Appearances 8 weeks postreconstruction.