Background
Basal Cell Carcinomas (BCC) is the most common type of skin cancer. Historically known as a “Rodent Ulcer” due to its characteristics of local invasion and bleeding. Metastatic spread is extremely rare, ranging from 0.0028% to 0.55% of all BCC cases. Limited case studies support a squamous component theory, or combination of immunodeficiency and stromal independence.
Methodology:
A 67-year-old male presented with an enlarging, fungating central back lesion with spinal column on show. Avoiding medical attention over several years resulted in physical decline, leg weakness and being wheelchair bound. Due to the worsening smell and family pressure he finally presented to the emergency department. A literature review using Medline, Pubmed and Google Scholar was conducted. Search terms included BCC and metastasis.
Results:
Mapping biopsies showed nodular and invasive BCC with no Squamous component. CT imaging confirmed widespread bony invasion T10 – L1 and spinal cord involvement with stenosis. Metastatic lung, axilla and splenic disease was confirmed requiring palliation. 200 to 300 reported cases of metastatic BCC are reported in the literature. Most manifest as a dissemination to the regional lymph nodes (60%) or hematogenous spread to the lung (42%), bone (20%), or skin (10%).
Conclusions:
Metastatic BCC is rare but possible in longstanding, large lesions. Their pathophysiology isn’t fully understood with more research required in the role that supportive stroma plays. Therapeutic options vary depending on the location and extent of metastatic BCC, but generally consist of surgery for local metastasis, and a combination of surgery, chemotherapy, and radiation therapy for distant metastasis.