Abstract
Giant keratinocyte tumors, in particular basal cell carcinomas of the scalp area, are a serious challenge for dermatosurgeons, oncologists, maxillofacial and reconstructive surgeons. The scalp area is limited in terms of skin mobility, and its elasticity decreases with age. The size of the tumors in this area and the degree of infiltration of the underlying tissues are important for the therapeutic choice - from surgical removal, waiting for granulationsto form and placing a split skin mesh graft (at a later stage), to performing complex rotational/transpositional or progressive flaps. Achieving an optimal aesthetic result is often the result of interventions carried out or based on the decisions of multidisciplinary teams. Alternatives such as radiotherapy and targeted therapy with vismodegib, for example, could be administered both preoperatively and postoperatively or as first-line therapy depending on tumor board decisions. We present a 69-year-old female patient with histopathologically proven preoperative giant basal cell carcinoma of the scalp that did not involve the tabula externa. Surgical treatment under general anesthesia was planned. A preoperative ultrasound was performed due to the repositioned area and the preservation of the feeding arteries. During the operation, the resection lines were in close proximity, but did not affect the arterial vessels. After applying the rotational advancement flap technique, under general anesthesia, an optimal cosmetic effect was achieved.