Metastatic Basal Cell Carcinoma: A Case Report

Abstract

An 86 year old lady presented to her GP with a 2 month history of right hip and left thigh pain. Pelvic plain x-rays revealed a lytic lesion in the left femur and right acetabulum. Thorough clinical examination found an 80 x 60 mm exophytic tumor with an ulcerated surface on her left shoulder. This had been present for over 4 years, the patient believing it just a patch of eczema. A subsequent CT chest, abdomen and pelvis revealed further bony lesions in her sternum, first rib and sacrum. A biopsy of the left shoulder lesion confirmed ulcerated basal cell carcinama (BCC). Hisological and immunohistochemical examination of a biopsy from the bony lesion in the sternum and first rib confirmed a diagnosis of metastaic BCC. Our patient commenced on treatment with imiquimod cream to the primary BCC, had a rod inserted into her left femur in order to prevent a pathological fracture and was offered palliative radiotherapy for the metastatic deposits, which she declined. She died six weeks later. Worldwide BCC incidence is increasing, but has very high cure rates with early complete surgical excision. Metastatic BCC is very rare but incidence is higher with larger tumors, because large vessel blood supply may facilitate haematological seeding of the tumor. Once it metastasises, BCC is highly malignant with short survival times, usually measurable in months. Our patient is likely to have had metastatic disease for some months prior to presentation.




J Med Cases. 2012;3(6):344-346
doi: https://doi.org/10.4021/jmc746w