Use of a perimeter technique with Mohs micrographic surgery in the resection of a giant basal cell carcinoma.

Background: Giant basal cell carcinomas (GBCC) can demonstrate very malignant behavior and pose a surgical challenge.

Objective: To present a surgical technique utilizing Mohs and the resection of narrow bands of tissue to excise a GBCC that created a large facial defect of 5 cm × 2 cm.

Methods: A unique combination of Mohs micrographic surgery and the recently described perimeter techniques used for lentigo maligna were used to resect the tumor.

Results: This hybrid technique was tissue sparing and therefore helped prevent the complications associated with a larger resection and allowed for an easier reconstruction. At 2 months post resection the patient had no known metastasis or tumor recurrence.

Conclusion: This case highlights the importance of early recognition of basal cell carcinoma and the complications that can arise when lesions are left untreated for a long duration. Also, we describe a surgical technique that could help reduce the complications associated with these large tumors.