Kirurško liječenje gigantskih bazocelularnih karcinoma lica: naše iskustvo

Ivan Kovačić, Marijan Kovačić, Marija Kera, Tamara Tačigin

Gigantski bazocelularni karcinom (GBCC) rijetki je tumor kože veličine 5 i više cm. Glavnim čimbenicima njegova nastanka smatraju se zapostavljanje konvencionalnoga bazocelularnog karcinoma (BCC) od strane bolesnika i/ili biološka agresivnost tumora. Svojim sporim infiltrativnim rastom narušavaju strukturni i funkcionalni integritet zahvaćenog područja. Za njegovo liječenje, bez obzira na lokalizaciju, ne postoje usvojene smjernice i još uvijek predstavlja terapeutski problem. U ovom radu analizirali smo karakteristike bolesnika i tumora kao i njegov odgovor na kirurško liječenje. Od ukupnog broja bolesnika s BCC-om glave i vrata u periodu od 11 godina izdvojili smo njih 24 s GBCC-om lica. Svi su bili treće životne dobi u rasponu od 65 do 86 godina, većinom siromašni, skloni alkoholu i depresiji. Veličina i površina tumora u središnjem dijelu lica bila je nešto manja nego u postraničnom dijelu. Prevladavao je muški spol u omjeru 1,4:1. Sve smo bolesnike podvrgnuli kirurškom liječenju odstranjenja tumora s histološki slobodnim rubovima te je istovremeno izvršena i rekonstrukcija nastalog defekta. Za vrijeme praćenja od prosječno 36 mjeseci nismo imali povrat bolesti niti pojavu metastaza, a funkcionalni i estetski rezultat bio je dobar. Histološki su u većini slučajeva bili neagresivni podtipovi tumora (nodularni), a vrijeme trajanja bolesti jest prosječno 5,9 godina. Za nastajanje GBCC-a kod naših bolesnika uglavnom teretimo njihov indolentan stav prema bolesti. GBCC se može uspješno kirurški liječiti i u tako zahtjevnom području kao što je lice i bez obzira na starosnu dob bolesnika.

Giant basal cell carcinoma (GBCC) is a rare skin tumor with the longest diameter greater than five cm. The main factors for its occurrence are considered to be the neglect of conventional basal cell carcinoma (BCC) by patients and the biological aggressiveness of the tumor. With its slow infiltrative growth it disrupts the structural and functional integrity of the affected area. There are no guidelines for its treatment regardless of localization and it still poses a therapeutic problem. In this study, we analyzed patient and tumor characteristics and response to GBCC surgical treatment. Of the total number of patients with BCC over a period of 11 years we isolated 24 cases with GBCC. All patients were in the third age range, from 65 to 86 years old, mostly poor, prone to
alcohol and depression. The size and area of the tumor in the central part of the face were slightly smaller than in the lateral part. Male gender predominated (1.4:1). All patients underwent surgical resection of the tumor with histologically confirmed free margins, as the only method of treatment. Reconstruction of the resulting defect was performed in the same procedure . During the follow-up of 36 months on average no recurrence of the disease or metastasis in any of the patients was observed. Histological processing also defined the subtype of these tumors. Most were non-aggressive, nodular form tumors. Due to the duration of the disease, an average of 5.9 years, we believe that the greatest responsibility for the development of this subtype of BCC is the indolent attitude of the patient. Facial GBCC can be successfully treated surgically in such a demanding area as the face, and regardless of the patient’s age.