Aggressive Basal Cell Carcinoma With Rib Metastasis: An Uncommon Presentation of a Common Skin Cancer

Area of Science:

• Oncology
• Dermatology

Background:

• Basal cell carcinoma (BCC) is the most common skin cancer, typically slow-growing with low metastatic potential.
• Rarely, neglected BCC can exhibit extensive local invasion and metastasis.

Observation:

• A 72-year-old woman presented with a neglected ulcerating facial tumor.
• Diagnosis confirmed BCC with extensive local invasion, maxilla, orbit, and palate destruction.
• Biopsy confirmed metastasis to the left anterior fifth rib.

Findings:

• The patient received a multimodal treatment approach.
• Treatments included vismodegib (hedgehog pathway inhibitor), cemiplimab (immune checkpoint blockade), palliative radiation, and surgical resection.
• This coordinated therapy resulted in clinical improvement and disease stabilization.

Implications:

• This case demonstrates the potential for aggressive behavior in neglected basal cell carcinoma.
• Emphasizes the critical importance of early detection for BCC.
• Highlights the value of comprehensive, multidisciplinary management for advanced BCC presentations.