Metastatic Basal Cell Carcinoma with Axillary Lymph Node Invasion Treated with Left Axillary Node Dissection

Basal cell carcinoma (BCC) is the most common skin cancer, accounting for 50% of all cancer in the U.S. Mortality is often considered negligible due to the rare rate of metastasis at 0.0028%. 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 referral to radiation oncology. Treatment of metastatic BCC consists of surgical excision of the primary tumor with adjuvant radiation therapy and chemotherapy if indicated for palliative measures. 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% five-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.