Extensive, neglected basal cell carcinoma of the half of the face-surgical treatment and reconstruction with an anterolateral microvascular thigh flap

Basal cell carcinoma (BCC) is the most common malignancy in humans [1, 2]. According to the Skin Cancer Foundation, estimated 2.8 million cases are diagnosed annually in the US. Non-melanoma skin cancers (NMSC), the most common neoplasms in Europe, the USA and Australia, despite their low mortality, pose a serious therapeutic, social and economic problem. Worldwide incidence is increasing by about 10% per annum, so the prevalence of basal cell tumor in the near future will equal that of all other cancers together [3]. Basal cell carcinoma occurs in 85–90% of cases on the head, often on the face above the line connecting the mouth corner with the ear lobe [4]. They are less often found in the lower part of the face and on the scalp. In 10–15% of cases, BCC is found on the neck, trunk and limbs. Location of the basal cell carcinoma is closely related to the exposure to ultraviolet radiation [5, 6]. Although rarely metastatic, it has potential of tremendous, in some locations, life-threating, regional destruction and disfigurement [7].
Diseases on the surface of the skin are usually visible and tend to be easily noticed both for health-care professionals and for patients themselves. However, cases of neglected, extensive skin neoplasms are still a fairly common phenomenon in the 21st century.
There are several different methods of treatment of BCC tumors: surgical (simple excision, Mosh’ micrographic surgery), destructive (cryosurgery, curettage and cautery) and non-surgical (photodynamic therapy, radiotherapy, topical-5-fluorouracil, imiquimod) [8, 9].
An advantage of surgical proceeding is the possibility of meticulous histological examination of the tumor type and margins of excision to establish clearance.
Early treatment produces cure rates of almost 100% (the suggested overall 5-year cure rates for primary and recurrent BCC are 99% and 94.4%, respectively) [10, 11]. In order to decide on the adequate treatment option, several factors should be taken into consideration: biological, histopathological and clinical features of the neoplasm as well as the patient condition. Exact determination of the skin cancer margins is of particular importance in case of lesions developing in areas where the reoperation of a recurring neoplasm would not be possible. When excision is incomplete, the recurrence rate is approximately 30% [12].
Basal cell tumors are easily treated in their early stages. The larger the tumor has grown, however,...


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