Neglected super giant basal cell carcinoma of the breast: Diagnostic pitfalls and multidisciplinary management

Basal cell carcinoma (BCC) is the most common skin cancer, typically indolent. However, rare variants such as giant BCC (GBCC, > 5 cm) and super giant BCC (SGBCC, > 20 cm) can be highly aggressive. Herein, we report a 47-year-old woman with a 21 cm ulcerated SGBCC of the breast, evolving over a decade despite a stable psychiatric history and high socioeconomic status. The lesion, with ulceration, superinfection, and infiltration, mimicked inflammatory breast cancer and pyoderma gangrenosum. Dermoscopy revealed atypical pigmentation with blue-gray blotches and concentric structures, aiding diagnosis. Histopathology confirmed an aggressive nodular-infiltrative BCC. She underwent wide excision of the pectoral muscle, followed by skin grafting, but graft necrosis required secondary healing. Adjuvant radiotherapy was recommended. This case highlights the destructive potential of neglected SGBCC, diagnostic challenges, and the need for early detection, multidisciplinary care, and individualized treatment, especially given the lack of established guidelines.