Metastatic Basal Cell Carcinoma Originating in the Supra‐Parotid Region

Abstract

This case illustrates that massive tumor size, ulceration, or history of multiple recurrences are not absolute prerequisites for metastatic BCC. It supports the hypothesis that tumor proximity to major lymphatic systems or large-caliber blood vessels may be of significance. BCCs originating in skin overlying the parotid gland have the potential to penetrate to a rich vascular and lymphatic plexus as well as compromise the integrity of the facial nerve. Early treatment of these neoplasms utilizing accurate methods of microscopic control appears warranted to prevent the serious consequences of recurrences and deep tissue involvement.

Aggressive Basal Cell Carcinoma with Invasion of the Parotid Gland, Facial Nerve, and Temporal Bone

“…Direct invasion of the parotid gland by BCC of the cheek and periauricular region has been infrequently reported in the English literature. [5][6][7][8][9][10][11] Because of the characteristically indolent nature of BCC, metastasis is a rare event. Parotid invasion by BCC is uncommon, with a reported incidence of 1.05% in one study of 1,146 cases of BCC.…”

“…6 However, proximity to overlying skin makes the gland particularly vulnerable to invasion, as the tumor must traverse only subcutaneous tissue, superficial muscle, aponeuroses, and fascia. 7 As such, there is no effective barrier to tumor progression in this region.…”

“…16 When such invasion is present, the trigeminal and facial nerves are the most frequently involved cranial nerves. 16,17 There have been few reports of BCC with documented facial nerve involvement over the past four decades, 7,9,13,[17][18][19][20][21][22][23][24] and such cases are rarely reported in the dermatologic literature.…”

Metastatic Basal Cell Carcinoma – A Dramatic Case

“…This observation may be explained by attempts at more conservative surgery in these areas leading to incomplete surgical excision. However, there is more agreement that tumours in these areas have an increased tendency to metastasize due to the thin skin and increased concentration of large calibre vessels in the area (9,11). Despite numerous reviews, it is unclear whether tumours are more likely to recur and subsequently metastasize because of their innate characteristics or because of unsuccessful treatment.…”

Basal Cell Carcinoma With Pulmonary and Lymph Node Metastasis Causing Death

“…While the usual MBCC is a large, ulcerated, locally invasive BCC of the head and neck that recurs despite repeated surgical procedures or radiotherapy, 14 these features are not absolute prerequisites for metastasis. 15 Immunosuppression does not appear to be a cause of MBCC. 16 In one review of 170 cases, the median interval between onset of BCC and metastasis was 9 years, with a range of less than 1 year to 45 years.…”