Metastatic Basal Cell Carcinoma: A Case Report

An 86 year old lady presented to her GP with a 2 month historyof right hip and left thigh pain. Pelvic plain x-rays revealed a lyticlesion in the left femur and right acetabulum. Thorough clinical examination found an 80 x 60 mm exophytic tumor with an ulceratedsurface on her left shoulder. This had been present for over 4 years,the patient believing it ‘just a patch of eczema’. A subsequent CTchest, 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 lesionin the sternum and first rib confirmed a diagnosis of metastaic BCC.Our patient commenced on treatment with imiquimod cream to theprimary BCC, had a rod inserted into her left femur in order to prevent a pathological fracture and was offered palliative radiotherapyfor the metastatic deposits, which she declined. She died six weekslater. Worldwide BCC incidence is increasing, but has very highcure rates with early complete surgical excision. Metastatic BCC isvery rare but incidence is higher with larger tumors, because largevessel 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 tohave had metastatic disease for some months prior to presentation.Keywords: Carcinoma; Basal Cell; Metastatic; Secondary; Neoplasm

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