Authors
Franco Rongioletti, Giorgio Filosa
Published in
Clinics in dermatology. Sep 29, 2026. Epub Sep 29, 2026.
Abstract
Advances in dermoscopy, skin cancer awareness, and modern oncologic therapies have made giant neglected cutaneous malignancies increasingly uncommon in industrialized countries. Nevertheless, exceptionally advanced tumors still occur and provide important insight into the psychological, social, and healthcare-related factors underlying extreme diagnostic delay. We aimed to describe a retrospective personal series of neglected terebrating cutaneous malignancies, identify the determinants of prolonged diagnostic delay, and highlight their clinical implications. We retrospectively reviewed patients with unusually large or deeply destructive malignant cutaneous tumors evaluated between 2005 and 2025. Clinical photographs, histopathologic findings, demographic and socioeconomic characteristics, and psychological factors were analyzed and interpreted in the context of the current literature. Twenty-two patients fulfilled the inclusion criteria (11 men and 11 women; mean age, 74 years; range, 69-99 years). The mean interval between lesion onset and specialist consultation was 5.3 years (range, 3-18 years). Histopathologic diagnoses included 14 giant basal cell carcinomas, four squamous cell carcinomas (including two verrucous carcinomas), two lentigo maligna melanomas, and two Merkel cell carcinomas. Diagnostic delay resulted from multiple interacting determinants. Although slow tumor growth contributed to the progressive enlargement of some lesions, psychological factors-including denial, fear of diagnosis or treatment, self-neglect, and psychiatric or cognitive disorders-emerged as the main drivers of prolonged neglect. Social isolation, socioeconomic vulnerability, limited healthcare access, and, less frequently, physician-related delays further contributed to disease progression. Neglected terebrating cutaneous malignancies remain rare but clinically important manifestations of advanced skin cancer in which prolonged diagnostic delay, rather than biological aggressiveness alone, determines disease severity. Psychological and behavioral factors play a pivotal role and should be actively recognized by dermatologists. Early identification of psychological distress, social vulnerability, and barriers to healthcare, together with a compassionate multidisciplinary approach, may help prevent these devastating yet largely avoidable presentations.
PMID:
42810645
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.
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