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. 2012:2012:157187.
doi: 10.1155/2012/157187. Epub 2012 Dec 6.

Metastatic Basal cell carcinoma: a biological continuum of Basal cell carcinoma?

Karaninder S Mehta  1 , Vikram K Mahajan, Pushpinder S Chauhan, Anju Lath Sharma, Vikas Sharma, C Abhinav, Gayatri Khatri, Neel Prabha, Saurabh Sharma, Muninder Negi
Affiliations

Metastatic Basal cell carcinoma: a biological continuum of Basal cell carcinoma?

Karaninder S Mehta et al. Case Rep Dermatol Med. 2012.

Abstract

Basal cell carcinoma (BCC) accounts for 80% of all nonmelanoma skin cancers. Its metastasis is extremely rare, ranging between 0.0028 and 0.55 of all BCC cases. The usual metastasis to lymph nodes, lungs, bones, or skin is from the primary tumor situated in the head and neck region in nearly 85% cases. A 69-year-old male developed progressively increasing multiple, fleshy, indurated, and at places pigmented noduloulcerative plaques over back, chest, and left axillary area 4 years after wide surgical excision of a pathologically diagnosed basal cell carcinoma. The recurrence was diagnosed as infiltrative BCC and found metastasizing to skin, soft tissue and muscles, and pretracheal and axillary lymph nodes. Three cycles of chemotherapy comprising intravenous cisplatin (50 mg) and 5-florouracil (5-FU, 750 mg) on 2 consecutive days and repeated at every 21 days were effective. As it remains unclear whether metastatic BCC is itself a separate subset of basal cell carcinoma, we feel that early BCC localized at any site perhaps constitutes a biological continuum that may ultimately manifest with metastasis in some individuals and should be evaluated as such. Long-standing BCC is itself potentially at risk of recurrence/dissemination; it is imperative to diagnose and appropriately treat all BCC lesions at the earliest.

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Figures

Figure 1
Figure 1
Panel 1: a nodulo-ulcerative basal cell carcinoma (BCC) plaque having characteristic indurated margins and pigmented crusts in the centre over back. Note the BCC lesion involving the margin of old linear scar. Panel 2: a large irregular nodulo-ulcerative fleshy plaque in left axilla. Puckering suggests adherence to other structures. Note typical beaded and pigmented borders and 3 morphologically similar lesions in its vicinity. Also note small satellite papulonodules indicative of local spread (arrow heads). Panel 3 (histology (A)): epidermis shows focal epidermal ulceration while dermis has numerous nests of basaloid cells (H and E, ×10). (B) The basaloid cells have increased mitotic activity and are arranged in peripheral palisading pattern with areas of central necrosis (H and E, ×40). (C and D) Tumor infiltrating the deeper layers is suggestive of infiltrative BCC (H and E, ×10 and ×40). Panel 4: CT scan (arrows) shows homogenously enhancing tumor infiltrating the underlying lymph nodes and muscles in right axilla (A) and left axilla (B). A subcutaneous tumor along the posterior axillary line (C). Enlarged lymph nodes in pretracheal region (D).
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