Yelva Lynfield MD, Cedarhurst, New York, USA on
Sept 17, 2004
This photo should be shown to everyone who thinks BCE is a
trivial tumor. After he finishes radiation this man will require
extensive reconstructive surgery.
Gabriela Frias MD, Mexico City, Mexico on
Sept 17, 2004
I've seen some similar cases, although treated by oncologist
who have done an extensive surgical resection and then a wonderful
made prosthesis was adapted by day, which looked very natural.
David Elpern MD, Williamstown, MA, USA on
Sept 18, 2004
My personal opinion is that this man should be left alone.
I think that no one has experience with this kind of patient
and the surgery will likely kill him. The post op period will
be extremely difficult. Radiotherapy will leave him with non-healing
radionecrosis. Chemotherapy does not work for BCC. There is
a time to "not just do something, but stand there."
There may be ENT cancer surgeons who can comment.
Michael Albom MD, Clinical Professor of Dermatology,
Ronald O. Perelman Department of Dermatology, New York University
Medical Center, New York, NY, USA on Sept 18, 2004
This patient's massive cutaneous facial neoplasm presents a
very serious dilemma in terms of management. I would suggest
that additional information is needed to evaluate this case.
An MRI or CT scan of the head and neck would help to assess
the depth and spread of invasion of disease and what critical
underlying anatomic structures are invaded by this neoplasm.
A needle biopsy would determine if the cervical adenopathy was
due to neoplastic or inflammatory cells. Immunochemical histologic
stains would be useful if the routine basic histochemical stains
showed equivocal histologic findings.
A single biopsy of the main tumor mass may not necessarily
be histologically representative of the entire neoplasm which
may actually consist of multiple histologic subtypes. In other
words, I have seem massive cutaneous tumors, such as this one,
that have demonstrated microscopic elements consistent with
basal cell carcinoma, squamous cell carcinoma and eccrine carcinoma.
In my experience, basal cell carcinomas with multiple types
of differentiation are more biologically aggressive in their
invasive capabilities as compared to ones that reveal only single
histologic patterns of basal cell carcinoma. This is a general
comment and not meant to be inclusive since infiltrative and/or
morphealike basal cell carcinomas can be extremely biologically
aggressive. ( For Full Commentary)
Zargari MD Rasht, Iran on
Sept 18 2004
I've seen two similar cases before. Radiotherapy and/or
chemotherapy might be palliative in this patient.
Benjamin Barankin MD, Department of Dermatology, University
of Alberta, Edmonton, Canada on Sept 19, 2004
I think that radiation therapy is the mainstay of treatment
for this gentleman, with guarded prognosis. If affordable/accessible,
I think a 3 month trial of imiquimoid would be beneficial.
Tom Rohrer MD, SkinCare Physicians of Chestnut Hill,
Boston, MA, USA on Sept 20, 2004
That is unbelievable! Wow, what a case. I think this could
only be done in a main Operation Room at a hospital and would
need wide excision with margin control followed by extensive
reconstructive surgery and radiation. That is really impressive.
Thanks for sharing.,
Henry Foong's note on Sept 29, 2004:
This patient underwent palliative radiotherapy without much
improvement. He passed away on Sept 27, 2004.