Basal Cell Carcinoma With Pulmonary and Lymph Node Metastasis Causing Death

Robinson, June K.; Dahiya, Madhu

doi:10.1001/archderm.139.5.643

Cited by 81 publications

(73 citation statements)

References 62 publications

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“…Thankfully, the incidence of metastatic basal cell carcinoma is rare, affecting just 0.028-0.5% of the population [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…One of the predictors of aggressive behaviour is a large primary, as large blood vessel supply may facilitate seeding of the tumor via the haematological route [3]. BCC's of the face and scalp are thought to have a greater tendency to metastasise because of the increased concentration of large-calibre vessels [4].The incidence of metastatic spread has been reported as 2% in BCC's with a diameter larger than 3 cm, 25% for diameters larger than 5 cm and 50% for tumors with a diameter larger than 10 cm [4].…”

Section: Discussionmentioning

confidence: 99%

“…Metastatic BCC is rare, affecting 0.028-0.5% of the population [2,3]. Once it metastasises BCC is highly malignant with short survival times, usually measurable in months.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic Basal Cell Carcinoma: A Case Report

Taylor

2012

J Med Cases

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An 86 year old lady presented to her GP with a 2 month history of right hip and left thigh pain. Pelvic plain x-rays revealed a lytic lesion in the left femur and right acetabulum. Thorough clinical examination found an 80 x 60 mm exophytic tumor with an ulcerated surface on her left shoulder. This had been present for over 4 years, the patient believing it 'just a patch of eczema'. A subsequent CT chest, abdomen and pelvis revealed further bony lesions in her sternum, first rib and sacrum. A biopsy of the left shoulder lesion confirmed ulcerated basal cell carcinama (BCC). Hisological and immunohistochemical examination of a biopsy from the bony lesion in the sternum and first rib confirmed a diagnosis of metastaic BCC. Our patient commenced on treatment with imiquimod cream to the primary BCC, had a rod inserted into her left femur in order to prevent a pathological fracture and was offered palliative radiotherapy for the metastatic deposits, which she declined. She died six weeks later. Worldwide BCC incidence is increasing, but has very high cure rates with early complete surgical excision. Metastatic BCC is very rare but incidence is higher with larger tumors, because large vessel blood supply may facilitate haematological seeding of the tumor. Once it metastasises, BCC is highly malignant with short survival times, usually measurable in months. Our patient is likely to have had metastatic disease for some months prior to presentation.

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“…Thankfully, the incidence of metastatic basal cell carcinoma is rare, affecting just 0.028-0.5% of the population [2,3].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Metastatic Basal Cell Carcinoma: A Case Report

Taylor

2012

J Med Cases

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“…Increased tissue invasion and extension of the tumor into adjacent anatomical structures also enhance metastatic potential (Snow et al, 1994). Immunosuppression and evidence of perineural spread or invasion of blood vessels have also been implicated as risk factors for metastasis (Robinson & Dahiya, 2003). For patients with metastatic disease, morbidity and mortality remain exceedingly high.…”

Section: Metastatic Basal Cell Carcinomamentioning

confidence: 99%

Basal Cell Carcinoma

Tuzun¹,

Kutlubay²,

Engın³

et al. 2011

Skin Cancer Overview

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“…Incomplete resection of primary and recurrent tumours can lead to substantial morbidity and even mortality (9). The majority of BCCs can be treated using standard techniques including conventional surgical excision, curettage, cryotherapy and radiotherapy.…”

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confidence: 99%

A reliable frozen section technique for basal cell carcinomas of the head and neck

Menesi¹,

Buchel²,

Hayakawa³

2014

CAN J PLAST SURG

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Basal cell carcinoma (BCC) is the most common skin cancer worldwide and represents 75% of cutaneous malignancies (1). The mortality rate from BCCs is <1% and metastases rarely occur (0.0028% to 0.5%) (2-6). Achieving clear margins, particularly with the more aggressive histological subtypes of BCC and in recurrent tumours, can prove challenging. In these scenarios, the visible clinical margin frequently underestimates the true extent of the tumour. This phenomenon is often referred to as subclinical tumour growth with fingerlike extensions. It is particularly common in the danger zone of the face (H zone), where BCCs often behave more aggressively and recur more frequently (7,8).Before reconstruction, it is imperative that the entire BCC be removed with negative pathological margins. Incomplete resection of primary and recurrent tumours can lead to substantial morbidity and even mortality (9). The majority of BCCs can be treated using standard techniques including conventional surgical excision, curettage, cryotherapy and radiotherapy. The recurrence rates for each of these techniques has been reported to be 3% to 42% following surgical excision (10-12), 3% to 9% with curettage (13,14), 4% to 17% following cryotherapy (10) and 7% to 10% after radiation (15).Mohs micrographic surgery (MMS) or frozen section have been recommended for difficult tumours such as recurrent tumours, tumours located in anatomically sensitive areas, aggressive histological subtypes, perineural invasion or large tumours >2 cm in size (7). Cure rates with MMS has proven better than with other treatment modalities, with low overall five-year recurrence rates of 0.6% to 3% for primary BCC, and 6% to 10% for recurrent . Disadvantages of MMS include the fact that it can be very time consuming, expensive and the reconstruction may be deferred if the Mohs surgeon is not comfortable with more involved reconstructive procedures.We evaluated the effectiveness of a surgeon-directed 'en face' frozen section technique that immediately evaluates the entire peripheral and deep margins during BCC resection and potentially offers a more efficient and equally effective alternative to MMS. METHODS PatientsThe study group comprised 50 patients who were treated by a single plastic surgeon (TH) in a tertiary centre. Fifty-three BCCs were evaluated. All tumours excised from the face over a five-year period (2002 to 2006) were retrospectively reviewed. The indications for 'en face' frozen section were recurrent tumours, tumours located in anatomically sensitive areas, aggressive histological subtypes, perineural invasion or large tumours >2 cm. The 'en face' method is a technique that permits examination of the entire tumour margin (20). The sections for the 'en face' method are cut very thin to enable maximal tissue preservation. Basal cell carcinomas (BCCs) of the head and neck treated by conventional techniques of surgical excision, curettage, cryotherapy and radiation therapy have recurrence rates of up to 42%. Mohs micrographic surgery (MMS) decreases the r...

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Basal Cell Carcinoma With Pulmonary and Lymph Node Metastasis Causing Death

Cited by 81 publications

References 62 publications

Metastatic Basal Cell Carcinoma: A Case Report

Metastatic Basal Cell Carcinoma: A Case Report

Basal Cell Carcinoma

A reliable frozen section technique for basal cell carcinomas of the head and neck

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