title: Denying the Obvious: Four Extreme Cases of Neglected Tumors.
abstract: BACKGROUND
  Little is known about the relatively common phenomenon of patients neglecting tumors as part of a denial mechanism to presumably cope with the obvious, outward and clearly visible signs of cancer. As a result of this tumor neglect, disease progression continues unchecked, resulting in excessive tumor growth, invasion of nearby structures, (often) metastatic spread, and significant disfigurement.
  
  
  METHODS
  In this case series, we present 4 extreme cases of neglected tumors that posed significant reconstructive challenges and explore the biopsychosocial components of tumor neglect.
  
  
  RESULTS
  In this series, we present 4 cases representing various cases of extreme tumor neglect. These 4 cases required multidisciplinary efforts involved in tumor resection, adjuvant treatments and the complex reconstructive efforts after tumor extirpation.
  
  
  CONCLUSIONS
  The tumor neglect phenomenon is of broad interest to the field of plastic and reconstructive surgery. Given the complex patient factors that contribute to the extreme state of disease progress upon presentation, all cases required extensive extirpative efforts with complex and challenging reconstructive solutions. Cases of extreme tumor neglect provide insight into the biopsychosocial underpinnings of this specific patient population and have implications for a further understanding of the potential immunoprotective effect of these large, longstanding, and often nonmetastatic tumors.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of General Surgery, and Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Block
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of General Surgery, and Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Young M
authors.initials: YM
authors.lastname: Jee
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of General Surgery, and Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Mustafa K
authors.initials: MK
authors.lastname: Baskaya
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of General Surgery, and Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bentz
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of General Surgery, and Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Poore