Nasal Basal Cell Carcinoma with Matrical Differentiation: Risk of Metastasis and Impact on Management

Basal cell carcinoma (BCC) is the most common type of skin cancer. Microscopically, BCC can be classified into indolent-growth and aggressive-growth subtypes. Additionally, uncommon variants have been described in the literature including adamantinoid, granular, clear cell, and BCC with matrical differentiation (BCCMD). If left untreated, BCC can invade locally causing significant tissue destruction while metastatic BCC is extremely rare. There have only been rare cases of BCCMD previously reported in the literature with none exhibiting metastasis. In this report, a 76 year old male patient presented to our center with a recurrent nasal lesion. He had been diagnosed with BCC at another institution about 8 years prior. He underwent a completion rhinectomy procedure, and on microscopic examination the tumor was diagnosed as BCCMD. In view of the uncommon pathology, a PET scan was ordered, which showed a left submandibular hypermetabolic lymph node with central areas of necrosis. A fine needle aspirate from the node confirmed metastasis, and the patient underwent subsequent neck dissection. In conclusion, we have presented a very rare case of a nasal BCCMD with regional metastasis. To the best of our knowledge, this constitutes the first reported case in the English literature. This might raise the possibility of a probable metastatic potential for this lesion and subsequently a more aggressive behavior. However, it is to be noted that this is a single case report and the affirmation of any metastatic potential would still need to be confirmed through additional future reports.