EXTENSIVE FACE BASAL CELL CARCINOMA: A CASE REPORT AND LITERATURE REVIEW

A.C.S, male, 65 years old, with significant cardiac disease and an extensive history with sun exposure, refers the appearance of pruritic, erythematous, scaly lesion with shallow ulcerations in the right eyebrow in the beginning of 2016. Submitted to an immediate incisional biopsy of the lesion, that showed basal cell carcinoma (BCC). He was initially treated in another institution with a shaving of the lesion, associated with the use of 5-Fluorouracil (5-FU) topic, for 21 days. The option for ablative therapy was due to his severe cardiologic case. However, these measures did not succeed, occurring the local progression of the lesion in the next 3 years. In 2019 the lesion occupied the entirety of the left front-temporal region. It became necessary a wide resection and a primary closing. The analysis of the surgical specimen confirmed the original diagnose and showed free and ample margins. At the moment the patient continues in outpatient care and doesnt show signs of tumor recurrence. BCC is the most common cancer in the world, its incidence has grown in the last few decades due to a life style of more sun exposure, mainly ultraviolet B rays. The superior part of the face is the main location that the tumor appears, it can be highly destructive and disfiguring, and rarely causes metastasis. The primary therapeutics would be the surgical excision of the lesion, where it could be associated with radiotherapy in cases where the margins are compromised and re-operating is contraindicated. The therapy with topic 5-FU can also be used with superficial BCC when there is no possibility of surgery, with a total regression in 90% of cases but with a higher possibility of recurrence than the surgical resection. The prognosis is considered very good, with a cure rate surpassing 90% but there are cases with important local morbidity on account of the infiltrative behavior of the tumor and the healing operations that mutilate the region. The non-melanoma skin cancers, despite having a low morbidity-mortality rate, are very frequent and their inadequate approach can create great deformities, due to the direct destruction by the tumor or the radical surgical procedure. The resection with free margins is the gold standard but ablative therapies can be used in selected situations. In the presented case, the association of scraping of the lesion + topic chemotherapy was not able to contain the progression of the lesion in medium term.