Treatment of giant basal cell carcinomas of the head and neck with aggressive resection and complex reconstruction.

Basal cell carcinoma is exceedingly common, but giant basal cell carcinomas (GBCCs) are rare. We retrospectively reviewed 34 patients with GBCC on the head and neck region treated with aggressive surgical excision and reconstruction in a single operative procedure.The large defects were reconstructed with 15 free tissue transfers and 20 pedicled muscle, musculocutaneous flaps, and skin flaps. We were able to observe 23 patients for a minimum 5 years after the surgery. Locoregional recurrence and/or distant metastasis were not observed in 22 patients. Only 1 patient with the scalp BCC had local recurrence between the flap and the normal tissue 2 years after the surgery. Recurrent tumor was widely excised and reconstructed with a skin graft. Our results imply that low complications, good oncologic control, and acceptable cosmetic results can be achieved by a 1-stage team approach with aggressive surgical resection and reconstruction.