Surgical management of giant nonmelanoma skin neoplasia

Background. Management of advanced integumentary malignancy has been contro versial. We have evaluated and treated 10 patients with giant nonmelanoma s kin neoplasias more than 8 cm in diameter. Methods. Aggressive surgical ablation was prospectively recommended to trea t giant basal cell or mixed basosquamous tumors and two purely squamous cel l tumors. Radiation therapy was given in three surgical patients. Our data are analyzed retrospectively. Results. Survival of the two patients who refused surgery was measured in w eeks. One patient who refused adequate surgery survived 9 months before dyi ng. All of the adequately treated surgical patients are alive as of this wr iting, including one who had subsequent resection of pulmonary metastases. Three patients required fi-ee tissue transfer. The average survival of surg ically treated patients was 2.7 years. Conclusion. An aggressive surgical approach to the management of advanced/g iant skin neoplasia is justifiable and the only treatment that may produce long-term survivability.