Supergiant Facial Basal Cell Carcinoma With Orbital Involvement: A Preventable Consequence of Delayed Diagnosis and Limited Access to Care

Supergiant basal cell carcinoma is an exceptionally rare presentation of an otherwise highly curable malignancy and is most often associated with prolonged neglect and limited access to care. We report a case of a 94-year-old man with a long-standing infiltrative facial lesion extending from the right preauricular and temporal region to the nasal sidewall and lower eyelid, associated with ectropion. Dermoscopy revealed blue-gray globules and pigmented ovoid nests, along with white structureless areas and a milky-red background. Biopsy confirmed pigmented basal cell carcinoma. Given advanced local invasion, frailty, and the unavailability of hedgehog pathway inhibitors in the public healthcare system, curative treatment was not feasible, and palliative radiotherapy was initiated. The patient deteriorated and died shortly thereafter; no evidence of metastatic disease was identified, and death was not attributed to basal cell carcinoma. This case highlights how delays in diagnosis and limited access to modern systemic therapies can transform a typically low-mortality cancer into a source of significant morbidity. Strengthening early detection strategies and improving access to guideline-based treatments remain critical to preventing such outcomes.