Basal cell carcinoma (BCC) is a nonmelanocytic skin cancer (ie, an epithelial tumor) that arises from basal cells (ie, small, round cells found in. Learn more from WebMD about basal cell carcinoma, the most common type of skin cancer, including its causes, symptoms, treatments, and. Basal cell carcinoma (BCC) is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in.

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Its metastasis is extremely rare, ranging between 0.

Basal Cell Carcinoma (BCC) –

A 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. 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.

Despite such a high prevalence its metastasis is extremely rare ranging between 0. Metastatic BCC typically occurs in middle-aged men having BCC of long duration, and the spread in order of frequency is usually to lymph nodes, lungs, bones, skin, or to other sites. However, in a metastatic BCC the primary cutaneous tumor must have distant metastatic lesions with histopathologic features identical to the primary tumor [ 5 ]. The described case is of metastatic BCC over the back with recurrence 4 years after excision and metastasis to regional lymph nodes, skin, soft tissues and muscles.

This year-old male presented with multiple noduloulcerative lesions over upper trunk. History revealed that he had a nodule over his back that was diagnosed pathologically as basal cell carcinoma BCCand a wide excision was performed 6 years ago.

Basal-cell carcinoma

During adallah 2 years the lesions had reappeared starting with the one over the old scar and were progressive in size and number. Cutaneous examination Figure 1Panels 1 and 2. Axillary lymph nodes were enlarged bilaterally.

They were firm in adalh and fixed to the overlying skin and deeper structures. The scalp, hair, nails, mucous membranes, and other systemic aealah showed no abnormality. Complete blood counts, serum biochemistry, X-ray chest, abdomen ultrasonography, and urinalysis nasalioma essentially normal.


Histologic examination of the nodule over the old scar revealed features of infiltrative BCC Figure 1Panel 3. Fine needle aspiration cytology from right axillary lymph node and a nodule over left scapular region was also suggestive of infiltrative BCC. There were no metastases noted in the pleurae, lung parenchyma, mediastinum, or underlying bones. All lesions progressively regressed in size after 3 cycles of chemotherapy which was well tolerated by him. Metastatic BCC remains a rare entity and basalooma males two times more often than females [ 6 ].

Age at presentation, the site and size of lesion, depth of invasion, duration and recurrence of disease, incomplete surgical resection, multiple lesions, and infiltrative histological pattern play some role in predicting metastasis [ 7 ].

The median age of onset for primary tumor is 45 years, and the median age at the time of metastasis is 59 years while the median interval between appearance of the primary tumor and metastasis is 9 years [ 2 ]. Giant BCC, commonly occurs on trunk, is aggressively destructive and possesses high metastatic potential probably due to bsalioma of large blood vessels leading to seedling of tumor via hematological route and its spread [ 41011 ]. Fair skin, trisomy adxlah chromosome 6, immunosuppression in affected patients, invasion of perineural space and blood vessels, multiple recurrences, and prior radiation therapy are some of the other risk factors described for metastasis in BCC [ 12 basaliomx, 13 ].

Metastasis to liver, other viscera, or subcutaneous tissues may occur following involvement of lymph nodes, lungs, or bones. Primary tumors may also invade deep into the extradermal structures such as cartilage, skeletal muscles, or bones. However, according to Lattes and Kessler [ 5 adaah to label a metastatic BCC the primary lesion must occur in the skin and not in a mucous membrane, metastasis must be at a site distant from the primary tumor and not merely a simple extension, and both primary and metastatic tumors must have similar histopathology.

Basal Cell Carcinoma (BCC)

All other features in our patient who had developed BCC at the age of 59 years, its localization over skin, recurrence of multiple lesions over trunk 4 years after its excision, metastasis to soft tissue and regional lymph nodes away from the primary site, and infiltrative histological pattern of both primary and metastatic lesions conforms to the diagnostic criteria proposed by Basalioms and Kessler [ 5 ].

However, it seems that it is not necessarily the BCC over head and neck region that gets metastasized as has been suggested by Malone et al. Adxlah of the underlying muscles in him too is a rare occurrence. Therapy of metastatic BCC depends upon the location and extent of the tumor and generally consists of wide surgical excision alone for local metastasis or its adakah with chemotherapy and radiation therapy for distant metastasis.


The main aim of the surgery is complete excision of the tumor with clear margins. Several chemotherapeutic agents including 5-FU, cis platin, vincristine, etoposide, bleomycin, cyclophosphamide, methotrexate, and doxorubicin have been used alone or in combination [ 15 — 17 ].

Although Pfeiffer et al. The prognosis for metastatic BCC generally remains poor, and average survival time is variable, 8 months in the presence of distant metastasis, 3. While overall metastatic risks of BCC perhaps remain underestimated, metastatic BCC for its rarity remains a difficult entity to characterize in terms of etiology, risk factors for metastasis, and therapeutic options.

As most cases have been bassalioma retrospectively, it remains unclear whether metastatic BCC constitutes a separate subset of basal cell carcinoma or not. It is even considered a complication of BCC with high morbidity and mortality by some workers [ 14 ]. We feel that early localized BCC perhaps constitutes a biological continuum that may ultimately lead to metastatic BCC in some individuals, and it must be evaluated as such.

Nevertheless, it is imperative to diagnose and treat all basal cell carcinomas at the earliest in view bsalioma paucity of knowledge on patient specific risk factors for metastasis, and the fact that a BCC neglected baaalioma longtime is potentially at basqlioma of metastases.

Vismodegib GDCa hedgehog signaling pathway inhibitor, has been approved recently by USFDA for treating patients with BCC which can not be treated with surgery or radiation and has recurred after surgery or metastasized. Case Reports in Dermatological Medicine. Subscribe to Table of Contents Alerts. Table of Contents Alerts. Case Report This year-old male presented with multiple noduloulcerative lesions over upper trunk.

Note the BCC lesion involving the margin of old linear scar. Puckering suggests adherence to other structures. Note typical beaded and pigmented borders and 3 morphologically similar lesions in its vicinity.

Basal and Squamous Cell Skin Cancer Stages

Also note small satellite papulonodules indicative of local spread arrow heads. Panel 3 histology A: 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. Metastatic basal cell carcinoma: View at Google Scholar M.

View at Google Scholar.