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Iron Deficiency Anemia Associated With Basal Cell Carcinoma: Case Report

By: Joshua D. Madera, MS
Posted: Tuesday, November 3, 2020

For patients with basal cell carcinoma, earlier intervention by a multidisciplinary team may prevent associated comorbidities and extensive treatment courses, according to a case report published in JAAD Case Reports. To the authors’ knowledge, this case demonstrated iron deficiency anemia with the lowest reported hemoglobin level associated with giant basal cell carcinoma, explained Jennifer Powers, MD, of the University of Iowa Hospitals and Clinics and VA Medical Center, Iowa City, and colleagues.

The patient was a 56-year-old woman who presented with worsening fatigue, lightheadedness, and dyspnea. Physical exam revealed tachycardia, hypertension, and fever. The patient presented with “fungating lesions on the right lateral aspect of the shoulder (11.0 x 20.0 x 2.5 cm), anterior mid portion of the chest (4.5 x 4.5 x 0.5 cm), and left lateral side of the neck (1.0 x 3.0 x 0.5 cm),” with associated drainage, bleeding, and tenderness upon palpation. Lab assessment revealed chronic iron deficiency anemia (hemoglobin = 4.4 g/dL; normal range 12–16 g/dL) and reduced mean corpuscular volume (61.6 mM), transferrin saturation (2%), and ferritin levels (10 ng/mL). Additional blood smear analysis was indicative of microcytic anemia with anisopoikilocytosis, which suggests regeneration of bone marrow. Furthermore, biopsy revealed invasive basal cell carcinoma positive for GATA3.

The study authors utilized vismodegib treatment, external-beam radiotherapy, and surgical reconstruction of the right lateral aspect of the shoulder. In addition, Mohs micrographic surgery was used to excise the left lateral aspect of the neck and chest. The patient was advised to continue iron supplementation for 3 months, which led to increased hemoglobin levels and discontinued fatigue, lightheadedness, and dyspnea. These findings demonstrate the importance of regular skin examinations to adequately manage any complications earlier in disease progression.

Disclosure: For full disclosures of the study authors, visit jaadcasereports.org.



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