Basal cell carcinoma presenting with profound anaemia.

Dermatological malignancy is the commonest form of cancer in the United Kingdom.1 Basal cell carcinoma accounts for approximately 80% of all non-melanocytic tumours, with a similar percentage affecting the head and neck.2 Tumour growth patterns are variable in this condition,3 with most interest focusing on 'rodent ulcers' affecting the head and neck. Little is known about the inherent biological behaviour of truncal basaliomas.4 We present a case of a giant exophytic basal cell carcinoma affecting the trunk, which presented with profound anaemia and generalised debility. CASE REPORT. A 50-year-old male was referred to our surgical unit with a tumour mass on the left anterolateral chest wall which had been present for at least 12 years. For two months prior to this, bleeding and a foul smell from the lesion had caused him social embarrassment. He also complained of extreme lassitude, palpitations, dyspnoea on exertion; he had lost two stones in weight, despite having a normal appetite and well-balanced diet. On examination the patient was pyrexic (38-5°C) and had signs of marked weight loss and of anaemia. He had sinus tachycardia, but no sign of cardiac or respiratory embarrassment. There was a mobile, ulcerated exophytic tumour 15 x 15 cm on his left anterior chest wall (Figure), which was superficially necrotic, ulcerated and bleeding. There was no evidence of regional lymphadenopathy or systemic dissemination of this tumour. The patient was of retiring disposition and reluctant to volunteer information. His affect was consistently incongruous; however, when challenged he admitted to having a deep-seated fear of cancer. Bacterial swabs grew a heavy mixed population of E. Coli, pseudomonas and bacteroides spp. Haematological investigation confirmed a microcytic anaemia (Hb 7-0 g/dl, MCV 64-4 fl, MCHC 27 g/dl, WCC 4-5 x 10 9/1, platelets 408 x 10 9/1) and hypoalbuminaemia (19 g/dl) with a rise in the serum globulin fraction to 49 g/dl (normal range 20-37). The ESR was 85 mm/hr. Radiological investigations were within normal limits.