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Metastatic basal cell carcinoma: A case report

  • Author(s): Júnior, Wilson de Oliveira Sousa
  • Ribeiro, Suilane Coelho
  • Vieira, Sabas Carlos
  • Carvalho, Teresinha Castelo Branco
  • Carvalho, Ana Lúcia
  • et al.
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Metastatic basal cell carcinoma: A case report
Wilson de Oliveira Sousa Júnior, Suilane Coelho Ribeiro, Sabas Carlos Vieira, Teresinha Castelo Branco Carvalho, and Ana Lúcia Carvalho
Dermatology Online Journal 9 (5): 18

Department of Surgical Oncology. São Marcos Hospital, Piauí Brazil. wosj@ig.com.br

Abstract

Basal cell carcinoma is the most common human cancer. Metastatic basal cell carcinoma is a rare clinical entity, with a reported incidence of only 0.0028-0.5 percent. We present a case of basal cell carcinoma on the back that metastasized to inguinal lymph nodes.



Introduction

Basal cell carcinoma is the most common human cancer [1]. It is most commonly located on the head and neck, and chronic local invasion is the usual course. Metastatic basal cell carcinoma is a rare clinical entity, with a reported incidence of only 0.0028-0.5 percent [2]. Metastases are most often found in lymph nodes, lung, bones, and internal organs [3].


Case report


Figure 1 Figure 2
Metastatic basal cell carcinoma of inguinal region (fig. 1)
Ulcerated metastatic inguinal tumor (fig. 2)

Figure 3 Figure 4
Lymph node section demonstrating neoplastic infiltration of the stroma (fig. 3) and peripheral palisading (fig. 4)

Figure 5
Giant basal cell carcinoma after reconstruction

A 65-year-old white male presented with bilateral lymphadenopathy in the inguinal region (fig. 1). The patient also complained of an ulcerated lesion on the lumbosacral area present for 20 years, rapidly growing for the last 6 months. Examination revealed a large, ulcerated tumor with elevated borders on the lumbosacral region and enlarged lymph nodes with overlying ulcer in the right inguinal region (fig. 2). There were no perianal lesions by inspection and digital exam.

Histological examination showed a neoplastic proliferation of atypical basaloid cells with scant cytoplasm and hyperchromatic and pleomorphic nuclei. Similar tumors present in the lymph nodes had multiple mitoses (typical and atypical). Rounded islands of cells with peripheral palisading infiltrated the adjacent fibrous stroma (figs. 3, 4).

The diagnosis of BCC metastatic to inguinal lymph nodes was made. Cloacal carcinoma was a consideration, but a thorough perianal investigation was unrevealing.

The patient underwent a wide excision of the tumor with reconstruction using a free skin transplant (fig. 5). Histology revealed lymphatic metastases of BCC affecting one of sixteen lymph nodes. Followup at 4 months has not revealed a recurrence.


Discussion

Basal cell carcinoma is the most common of the cutaneous malignancies, accounting for 65-75 percent of all skin cancers [2]. These carcinomas are usually slow-growing, locally aggressive tumors that rarely metastasize [4]. The reported frequency of metastatic dissemination is estimated at 0.0028-0.5 percent. BCC metastasizes most frequently to lymph nodes but also spreads hematogenously to viscera and bone [1].

Approximately 85 percent of metastatic BCCs occur in the head and neck region [2]. Occurrences on the trunk and extremities are uncommon. Risk factors for the development of metastatic basal cell carcinoma include a history of persistent BCC for many years (as in this case), lack of response to conventional methods of treatment, and previous radiation treatment [5]. Large, neglected, ulcerated, locally invasive and uncontrolled tumors are most prone to metastasize [1]. Metastases usually occur after multiple local recurrences. There is apparently no correlation between the histologic subtype of BCC and the occurrence of metastasis. It is important to treat BCC promptly and adequately and to have attentive followup to avoid the risk of metastasis to regional lymph nodes or distant sites [4]. Early excision of the primary tumor remains the best method of treatment.

Regional lymph node metastases may be treated by radical lymph-node dissection. Systemic metastases may require a combination of chemotherapy, radiation therapy, and surgery [6]. The prognosis is very poor for patients with localized lymph node metastases; the median survival time is 3.6 years.

References

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2. Malone JP, Fedok FG, Belchis DA, Maloney ME. Basal cell carcinoma metastatic to the parotid: report of a new case and review of the literature. Ear Nose Throat J. 2000 Jul;79(7):511-5, 518-9. PubMed

3. Jarus-Dziedzic K, Zub W, Dziedzic D, Jelen M, Krotochwil J, Mierzejewski M. Multiple metastases of carcinoma basocellulare into spinal column. J Neurooncol. 2000 May;48(1):57-62. PubMed

4. Baker PB, Berggren R. Metastatic basal cell carcinoma: review and report of a case. Ann Plast Surg. 1983 Nov;11(5):428-30. PubMed

5. Snow SN, Sahl W, Lo JS, Mohs FE, Warner T, Dekkinga JA, Feyzi J. Metastatic basal cell carcinoma. Report of five cases. Cancer. 1994 Jan 15;73(2):328-35. PubMed

6. Grace GT, Elias EG. Metastatic basal cell carcinoma. Md Med J. 1991 Sep;40(9):799-801. PubMed

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