Metastatic Basal Cell Carcinoma: A Biological Continuum of Basal Cell Carcinoma?

Abstract

Basal cell carcinoma (BCC) accounts for 80% of all nonmelanoma skin cancers. Its metastasis is extremely rare, ranging between 0.0028 and 0.55 of all BCC cases. The usual metastasis to lymph nodes, lungs, bones, or skin is from the primary tumor situated in the head and neck region in nearly 85% cases. A 69-year-old male developed progressively increasing multiple, fleshy, indurated, and at places pigmented noduloulcerative plaques over back, chest, and left axillary area 4 years after wide surgical excision of a pathologically diagnosed basal cell carcinoma. The recurrence was diagnosed as infiltrative BCC and found metastasizing to skin, soft tissue and muscles, and pretracheal and axillary lymph nodes. Three cycles of chemotherapy comprising intravenous cisplatin (50 mg) and 5-florouracil (5-FU, 750 mg) on 2 consecutive days and repeated at every 21 days were effective. As it remains unclear whether metastatic BCC is itself a separate subset of basal cell carcinoma, we feel that early BCC localized at any site perhaps constitutes a biological continuum that may ultimately manifest with metastasis in some individuals and should be evaluated as such. Long-standing BCC is itself potentially at risk of recurrence/dissemination; it is imperative to diagnose and appropriately treat all BCC lesions at the earliest.

Vitamin D derivatives enhance cytotoxic effects of H2O2 or cisplatin on human keratinocytes

“…It is considered in combinational therapy of skin cancer including metastatic basal cell carcinoma [71]. Cisplatin can induce apoptosis of HaCaT cells by a hydroxyl-radical mediated mechanism [72].…”

Metastatic basal cell carcinoma to the lungs: Case report and review of literature

“…Many risk factors that appear to predispose patients to MBCC have been identified, including long duration, site (seen with primary tumor in the head and neck region especially mid face or ears which is seen in 85% of cases) and size of the tumor, number of lesions, depth of invasion, persistence of BCC for many years, recurrence despite optimal treatment, BCC refractory to conventional methods of treatment, infiltrative histological pattern, incomplete surgical resection and previous radiation therapy either in early adulthood or for localized cancer. [ 1 5 6 ] It has been seen that most primary metastatic lesions are more than 3 cm in diameter. [ 4 ] Amongst the various histological subtypes of BCCs, the superficial, infiltrative/morpheaform and micronodular subtypes have a high propensity for recurrence and metastasis.…”

“…[ 6 ] However this is controversial and there is no evidence to support that a particular subtype predisposes to MBCC. [ 1 ] Primary BCC metastasises usually via lymphatics, although it also spreads hematogenously. Metastasis most commonly occurs in regional lymph nodes, lung and bone although cases involving the spinal cord, parotid gland, skin, bone marrow, spleen, liver, adrenal glands, brain, dura mater, esophagus, heart and kidney have been documented.…”

“…Despite the high incidence of BCC, metastatic BCC is extremely rare and is seen in 0.0028-0.55% with approximately 250 cases reported. [ 1 2 ] Most metastases occur in men. The BCCs from which they arise are commonly large, facial, locally invasive and destructive, ulcerated, long-standing, treatment-resistant and histologically aggressive.…”

Vismodegib: The Proof of Concept in Basal Cell Carcinoma

“…A significant response rate was reported with a combination of paclitaxel, 5-FU or blemomycin 17,18. In one report, a complete regression of the tumor was observed after three cycles of combined cisplatin and 5-FU chemotherapy 19. In another case report, the authors observed a complete response with a combination of paclitaxel and carboplatin in lung metastatic BCC 17.…”