Abstract
OBJECTIVE: Giant basal cell carcinoma (GBCC) of the face is a rare, disfiguring entity with poorly understood psychological challenges and factors contributing to social isolation. This study evaluates the reasons for delays in care in this patient population. METHODS: A retrospective review of patients with GBCC of the face (>5 cm) treated at a tertiary care academic center from January 2003 to May 2024 was conducted. The clinical course, time to presentation, insurance type, and geographic factors were analyzed to identify causes for delay. Telephone interviews assessed reasons for delays in care. The Hospital Anxiety and Depression Scale (HADS) was administered and compared with a control group. RESULTS: A total of 39 patients with GBCC were identified; 16 patients consented to interviews. The average lesion length was 64.5 mm. Patients presented on average 6 years (range: 0.5-18 years) after noticing the lesion, citing denial or financial concerns as reasons for delay. HADS results showed increased anxiety (p = 0.01) compared with controls. Additionally, 33.3% of patients reported habitual alcohol use, and 43.8% lived alone. Geographical analysis showed lower high school graduation rates (p < 0.001). No significant socioeconomic predictors for insurance type or treatment delays were found. CONCLUSION: This study reveals the substantial psychosocial challenges experienced by patients with GBCC of the face. Increased anxiety, social isolation, and lower education levels contribute to delays in care. This subpopulation would benefit from targeted social support and health literacy interventions as they may be crucial to their final treatment recommendations and outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 135:2335-2341, 2025.