Case Study - Metastatic Basal Cell Carcinoma with Axillary Lymph Node Invasion in a 71-Year-Old Male, Treated with...

Basal cell carcinoma (BCC) is the most common skin cancer, accounting for 50% of all cancer in the United States. Mortality is often considered negligible due to the rare rate of metastasis at 0.0028% or 1 in 1,000,000 BCC diagnoses. There are on 230 reported cases of metastatic basal cell carcinoma in the world literature review. When it does spread, it usually involves the lymph nodes, lungs, and bones. BCC carcinoma is considered high-risk or severe if the tumor is greater than 5 cm in size, is a recurrent lesion, located on the face, or has perineural/perivascular invasion.

A 71-year-old fair-skinned male with a history of more than 34 documented skin carcinomas presented to his dermatologist with a non-painful, mobile, growing mass in his left axilla. Biopsy revealed metastatic basal cell carcinoma. Left axillary node dissection was performed in which perineural, perivascular, and perimuscular invasion was noted. Invaded structures were excised, and the patient reported no long-lasting sequelae following surgery. Patient refused use of chemotherapy.

Treatment of metastatic BCC consists of surgical excision of the primary tumor with adjuvant chemotherapy and radiation therapy. Chemotherapeutic regimens often include one or more of the following: 5-FU, cisplatin, vincristine, etoposide, bleomycin, cyclophosphamide, methotrexate, doxorubicin, as well as the new options of vismodegib and sonidegib. Despite surgical excision with adjuvant chemotherapy, metastatic basal cell carcinoma has been found to have a dismal 56% 5-year and 27% 10-year survival rate. The best way to increase survival is through early diagnosis and wide surgical excision with clear margins followed by chemotherapy.