Clinical observations of generalized and inoperable locally advanced forms of basal cell carcinoma

Abstract

Background. Basal cell carcinoma (BCC) occupies around 80% of all the cases of diagnosed skin cancer (according to American Cancer Society). In various countries of the world the morbidity rate of BCC differs due to the main predisposing factor of BCC development – ultraviolet radiation. In Ukraine, according to National Cancer Registry, 15882 new cases of non-melanoma skin cancer were registered in 2019–2020. Standardized morbidity rate of this pathology increased by 2,6% compared to 2018. Basal cell cancer commonly recurs (according to different experts, the rate varies from 10% to 80%), at the same time, distant metastases are diagnosed quite rarely. Understanding contribution of Hedgehog (Hh) signaling pathway to carcinogenesis of BCC has become a serious achievement in molecular biology. In spite of relatively benign course of BCC and variety of treatment methods of this disease, there is a high risk of recurrence, and in some patients, lesions may progress to such extent that they become unsuitable for local therapy which makes it urgent to search for alternatives to surgery and radiation therapy.
 Purpose – to study the peculiarities of course, treatment, development of complications of recurrent, locally advanced, metastatic inoperable BCC by the example of clinical cases. Materials and methods. Clinical observation of female patient K., 73 years old, who was undergoing treatment in the Department of Clinical Oncology and Hematology by reason of multiple BCC lesions (observation time 14 years) and female patient D., 42 years old, who was undergoing treatment in the Department of Radiation Pathology and Palliative Care by reason of aggressive course of locally advanced form of basalioma (observation time 29 years). Observation and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».
 Results. The clinical cases of observation and different stages of treatment of patients with constantly recurring aggressive BCC over a long period of time, 14 and 29 years, are demonstrated. Metastasing of BCC is confirmed in both cases, local advancement is shown, various methods of treatment were used: surgery, radiation therapy, cryodestruction, chemotherapy. Difficulty of patients' management is shown, especially when all available methods are used up. Treatment of complications of special therapy methods, multistage restoring plastic surgeries using different methods of plastic repair are described.
 Conclusions. Treating recurrent, metastatic, and locally advanced inoperable forms of BCC when one runs out of possibilities of the main treatment methods – surgery, radiation therapy, chemotherapy is a difficult task which requires further development of modern technology and treatment methods.