A neglected basal cell carcinoma in a young patient:successful treatment with immunocryosurgery


  • Georgios Gaitanis Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
  • Micheal Tronnier Klinik für Dermatologie, Venerologie und Allergologie, Klinikum Hildesheim GmbH, Hildesheim, Germany
  • Aikaterini Zioga Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
  • Panagiota Spyridonos Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
  • Ioannis D. Bassukas Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece




Basal cell carcinoma, Neglect, Imiquimod, Cryosurgery, Immunocryosurgery, Non-surgical treatment


Patients with neglected basal cell carcinomas (BCC) still represent in many cases a therapeutic challenge. When feasible, surgery is the preferable approach; however, surgical treatment of large tumors may require extensive reconstruction, occasionally with substantial functional and aesthetic sequels. Currently, non-surgical modalities are intensively evaluated for BCC. In one of authors’ departments the combination of cryosurgery during continuous daily imiquimod (immunocryosurgery) has been established as an effective, office-compatible tissue sparing treatment for all BCC <2cm in maximal diameter, including tumor relapses, and selected cases of larger tumors. Herein we exemplary demonstrate this modality by presenting the remarkable case of a young female patient with a giant (6x5 cm) BCC at her right temporal region that was successfully treated with immunocryosurgery: Complete clearance was achieved after five treatment courses, with corresponding treatment pauses, over a period of 11 months; the tumor remains relapse-free after 24 months follow up. Socioeconomic reasons and failure to pursue adequate health-care facilities may have contributed to neglect in the present patient. In conclusion, neglected, not complicated BCC in young patients can be successfully treated with non-surgical modalities, like immunocryosurgery.


Harris RB, Griffith K, Moon TE. Trends in the incidence of nonmelanoma skin cancers in southeastern Arizona, 1985-1996. J Am Acad Dermatol. 2001;45:528-36.

Skellett AM, Hafiji J, Greenberg DC, Wright KA, Levell NJ. The incidence of basal cell carcinoma in the under-30s in the UK. Clin Exp Dermatol. 2012;37:227-9.

Telfer NR, Colver GB, Morton CA; British Association of Dermatologists. Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008;159:35-48.

Hauschild A, Breuninger H, Kaufmann R, Kortmann RD, Klein M, Werner J, et al. Brief S2k guidelines - basal cell carcinoma of the skin. J Dtsch Dermatol Ges. 2013;11(Suppl 3):10-5.

Nakuçi M, Bassukas ID. Office-based treatment of basal cell carcinoma with immunocryosurgery: feasibility and efficacy. Acta Dermatovenerol Alp Pannonica Adriat. 2013;22:35-8.

Gaitanis G, Bassukas ID. Immunocryosurgery for non-superficial basal cell carcinoma: a pro-spective, open-label phase III study for tumours ≤2 cm in diameter. Acta Derm Venereol. 2014;94:38-44.

Gaitanis G, Bassukas ID. Intralesional bevacizumab as in-add adjuvant to immunocryosurgery for locally advanced basal cell carcinoma. J Eur Acad Dermatol Venereol. 2014;28:1117-21.

Gaitanis G, Nomikos K, Vlachos C, Bassukas ID. Immunocryosurgery for patients with therapeutically challenging basal cell carcinomas: report of two representative cases. J Dermatolog Treat. 2012;23:70-1.

Spyridonos P, Gaitanis G, Bassukas ID, Tzaphlidou M. Gray Hausdorff distance measure for medical image comparison in dermatology: evaluation of treatment effectiveness by image similarity. Skin Res Technol. 2013;19:e498-506.

Gaitanis G, Spyridonos P, Patmanidis K, Koulouras V, Nakos G, Tzaphlidou M, et al. Treatment of toxic epidermal necrolysis with the combination of infliximab and high-dose intravenous immunoglobulin. Dermatology. 2012;224:134-9.

Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166:1069-80.

Rosen H, Schmidt B, Lam HP, Meara JG, Labow BI. Management of nevus sebaceous and the risk of Basal cell carcinoma: an 18-year review. Pediatr Dermatol. 2009;26:676-81.

Idriss MH, Elston DM. Secondary neoplasms associated with nevus sebaceus of Jadassohn: a study of 707 cases. J Am Acad Dermatol. 2014;70:332-7.

Mills O, Thomas LB. Basaloid follicular hamartoma. Arch Pathol Lab Med. 2010;134:1215-9.

El-Darouti MA, Marzouk SA, Abdel-Halim MR, Zidan AZ, Fawzy MM. Basaloid follicular hamartoma. Int J Dermatol. 2005;44:361-5.

Brownstein MH. Basaloid follicular hamartoma: solitary and multiple types. J Am Acad Dermatol. 1992;27(2 Pt 1):237-40.

Nelson BR, Johnson TM, Waldinger T, Gillard M, Lowe L. Basaloid follicular hamartoma: a histologic diagnosis with diverse clinical presentations. Arch Dermatol. 1993;129:915-7.

Jaqueti G, Requena L, Sánchez Yus E. Trichoblastoma is the most common neoplasm developed in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases. Am J Dermatopathol. 2000;22:108-18.

Hurt MA, Cribier B, Kaddu S, Kutzner H, Cribier B, Schulz T, et al. Benign tumours with follicular differentiation. In: LeBoit PE, Burg G, Weedon D, Sarasain A. eds. World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours. Lyon: IARC Press; 2006: 152.

Dasgeb B, Mohammadi TM, Mehregan DR. Use of Ber-EP4 and epithelial specific antigen to differentiate clinical simulators of basal cell carcinoma. Biomark Cancer. 2013;5:7-11.

Kechijian P, Connors RC, Ackerman AB. Trichoepithelioma vs. basal-cell carcinoma: criteria for histologic differentiation. J Dermatol Surg. 1975;1:22-3.

Gaitanis G, Ganiatsa A, Karamoutsios A, Vartholomatos G, Bassukas ID. A prospective phase III clinical trial of immunocryosurgery for basal cell carcinoma< 2 cm: confirmation of effectiveness and evidence for immunomodulatory action. J Invest Dermatol. 2012;S132:66.

Shevach EM. Biological functions of regulatory T cells. Adv Immunol. 2011;112:137-76.

Ohkura N, Kitagawa Y, Sakaguchi S. Development and maintenance of regulatory T cells. Immunity. 2013;38:414-23.

Kricker A, Armstrong B, Hansen V, Watson A, Singh-Khaira G, Lecathelinais C, et al. Basal cell carcinoma and squamous cell carcinoma growth rates and determinants of size in community patients. J Am Acad Dermatol. 2014;70:456-64.

Varga E, Korom I, Raskó Z, Kis E, Varga J, Oláh J, et al. Neglected basal cell carcinomas in the 21st century. J Skin Cancer. 2011;2011:392151.

Lyons TG, O’Kane GM, Kelly CM. Efficacy and safety of vismodegib: a new therapeutic agent in the treatment of basal cell carcinoma. Expert Opin Drug Saf. 2014;13:1125-32.

Basset-Seguin N, Sharpe HJ, de Sauvage FJ. Efficacy of hedgehog pathway inhibitors in basal cell carcinoma. Mol Cancer Ther. 2015;14:633-41.

Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation. J Dtsch Dermatol Ges. 2015;13:277-90.

Strasswimmer J, Latimer B, Ory S. Amenorrhea secondary to a vismodegib-induced blockade of follicle-stimulating hormone-receptor activation. Fertil Steril. 2014;102:555-7.