Metastatic basal cell carcinoma with evidence of intravascular invasion: A case report

Although basal cell carcinoma is the most common malignancy in humans, intravascular basal cell carcinoma is rarely reported in the literature. A 78-year-old male presented for Mohs Micrographic surgery of a 1.5 by 1.5 cm² nodular and focally infiltrative basal cell carcinoma on the left parietal scalp. In the fifth stage, intravascular tumor cells were noted, and the patient was still positive in five out of six specimens with a defect measuring 6.5 × 7.0 cm². Mohs surgery was stopped due to concern of widespread disease. A positron emission tomography/computed tomography scan was ordered that demonstrated diffuse prominent activity in the cervical level IIa nodes, right sacrum, right scapula, and the third left rib, concerning for metastatic disease. This case emphasizes the importance of vigilance to examine high-risk basal cell carcinoma pathology for intravascular invasion in addition to perineural invasion, especially in the setting of high risk factors for metastatic basal cell carcinoma.