Imaging findings of basaloid squamous cell carcinoma: a case report

Basaloid squamous cell carcinoma (BSCC) is a rare, high-grade variant of SCC. In the oral cavity, BSCC predominantly originates from the floor of the mouth and base of the tongue and is characterized by aggressive behavior, with frequent nodal and distant metastases. To date, no case has comprehensively reported BSCC findings across multiple imaging modalities in a single patient. A 78-year-old male presented with persistent erythema, swelling, and pain in the anterior mandible. Clinical examination revealed exposed bone with an exophytic soft tissue mass and cutaneous fistula. The lesion was initially suspected to represent osteoradionecrosis following prior management of SCC (pT1N0M0) with laser resection, neck dissection, and radiotherapy. However, disease recurrence could not be excluded. Panoramic radiography showed an ill-defined radiolucency in the anterior mandible. CT revealed a 55 × 20 × 48 mm inhomogeneously enhancing mass with associated bone destruction and extending to the skin. MRI demonstrated alveolar and labial cortical bone destruction, with soft tissue component isointense to muscle on T1-weighted images and heterogeneous high signal on T2-weighted and T1-weighted contrast enhanced images. PET-CT showed high FDG uptake (SUVmax: 17.2) without nodal or distant metastasis. Biopsy findings were suggestive of BSCC, which was confirmed by histopathologic examination of the resected lesion. This report highlights the utility of multimodal imaging in lesion characterization and supporting clinical decision-making, while the histopathological examination remains the gold standard for the definitive diagnosis. It also underscores the importance of vigilant follow-up in patients with oral BSCC for early detection of local recurrence and distant metastases.