Purpose To present a case of metastatic basal cell carcinoma (BCC).
Introduction BCC is the most common skin cancer in the United States. Metastasis of BCC is rare; only approximately 200 cases have been reported in the world literature. Death from nonmelanoma skin cancer is also not always accurately recorded; however, estimated mortality is very low, at less than 2,000 people yearly.
Case Presentation A 62-year-old white male with recurrent BCC of the left posterior triangle of the neck previously treated with wide local excision on two occasions presented to the ENT clinic for routine follow-up. The patient was found to have subcutaneous nodules on his neck that did not involve the skin at the excision site. A CT neck was ordered for further evaluation, and the lesions were subsequently biopsied. Pathology revealed recurrent basal cell. The patient underwent radical neck dissection. CT of the chest was performed and revealed multiple pulmonary nodules. Interventional radiology was consulted for biopsy of one of the pulmonary nodules. The specimen was submitted to pathology and revealed metastatic BCC to the lung. Subsequently, the patient began systemic chemotherapy with Taxol/carboplatin. The patient is currently undergoing treatment.
Discussion At least 90% of BCCs are cured with the initial therapeutic modality, which may include cryosurgery, photodynamic therapy, topical immunomodulators, local excision, and Mohs' micrographic surgery. In most cases, BCCs have an indolent growth pattern. Locally invasive tumors can develop over years from patient neglect. The risk of metastasis or invasion of vital structures by BCCs is extremely low, with an estimated incidence of 0.03%. Because BCC is not commonly reported to cancer registries in the United States, the true incidence cannot be determined. Most metastatic or deeply invasive BCCs are located on the head and neck. Regional lymph nodes are the most common site of metastatic disease, followed by the lung.
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