Ulcerated Metatypical Basal Cell Carcinoma of the Forehead

An 81-year-old male presented with an ulcerated lesion on the frontal area. The lesion had started three years before with a small ulceration and was initially treated with a cream of betamethasone and fusidic acid twice daily for several months. The clinical impression was ulcerated basal cell carcinoma (BCC). The histopathological findings after surgical excision were consistent with metatypical or basosquamous carcinoma. The importance of metatypical and basosquamous carcinomas is their potential for a more aggressive behaviour than conventional BCC, both regarding local recurrences and metastatic disease. Clinicians should be aware of the more aggressive behaviour of metatypical BCC since it may influence the protocols of follow-up of these patients to timely detect local recurrences and/or metastatic disease.