Clinical review
Metastatic basal cell carcinoma: Report of five cases and review of 170 cases in the literature

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We report five cases of metastasizing basal cell carcinoma. The incidence of metastases in all patients with basal cell carcinomas who had surgery in the same period was 0.1%. There was no squamous differentiation in the histology of any of the primary lesions, but we found some squamous differentiation in a late recurrence in one patient and in the metastases in two patients. All other histologic features were identical in both the primary tumor and in the metastases. Perineural spread and blood vessel invasion were evident in the primary tumor and/or recurrence of three of the five patients and may be important pointers to possible recurrence and metastasis. Of 205 cases of metastasizing basal cell carcinomas mentioned in the literature, we accepted and evaluated 170 cases of tumors of the skin with histologic proof of metastasis. The male-to-female ratio was 2:1, median age at onset of primary tumor, 45 years, median interval between onset of tumor and first sign of metastasis, 9 years, median age at first sign of metastasis, 59 years, and median survival after first sign of metastasis, only 8 months. The site of the primary tumors is similar to that in nonmetastasizing basal cell carcinoma. Metastatic spread is most often to lymph nodes, lungs, and bones with lymphogenic and hematogenic spread equally frequent. Age or sex of the patient seemed to have no influence on survival or way of metastatic spread. As metastasis of basal cell carcinoma is extremely rare (1 in 1,000 to 35,000), many authors sought or postulated histologic “degeneration” into a squamous cell carcinoma, but no such unequivocal evidence has ever been found. Areas of squamous differentiation were reported in less than 15% of both primary and metastatic lesions of metastasizing basal cell carcinoma. The mode of metastatic spread and the characteristics of the histology make it rather unlikely that metastasis of a basal cell carcinoma is due to a change toward squamous cell carcinoma.

References (159)

  • K Paver et al.

    The incidence of basal cell carcinoma and their metastases in Australia and New Zealand

    Australas J Dermatol

    (1973)
  • D Weedon et al.

    Metastatic basal cell carcinoma

    Med J Aust

    (1975)
  • RS Cotran

    Metastasizing basal cell carcinomas

    Cancer

    (1961)
  • J Conley

    Cancer of the skin of the nose

    Ann Otol Rhinol Laryngol

    (1974)
  • T Lakshmipathi et al.

    Metastasizing basal-cell carcinoma

    Br J Dermatol

    (1967)
  • Z Wronkowski

    Metastases in dermal basal cell carcinoma

    Nowotwory

    (1968)
  • S Cade
  • CF Beadles

    Rodent ulcer

    Trans Pathol Soc Lond

    (1894)
  • ER Farmer et al.

    Metastatic basal cell carcinoma: A clinicopathologic study of seventeen cases

    Cancer

    (1980)
  • A Sakula

    Pulmonary metastases from basal-cell carcinoma of skin

    Thorax

    (1977)
  • EJ Van Scott et al.

    The modulating influence of stromal environment on epithelial cells studied in human autotransplants

    J Invest Dermatol

    (1961)
  • JC Amersbach

    Metastatic basal cell epithelioma

    Arch Dermatol Syph

    (1947)
  • D Assor

    Basal cell carcinoma with metastasis to bone

    Report of two cases. Cancer

    (1967)
  • HA Baxter et al.

    Metastasizing basal cell carcinoma

    Am J Clin Pathol

    (1967)
  • G Beretta et al.

    Carcinoma basocellulare cutaneo metastatizzante con anemia mieloftisica

    Tumori

    (1970)
  • MH Bergoend

    Métastases d'un épithélioma basocellulaire

    Bull Soc Fr Dermatol Syph

    (1964)
  • R Bezecny

    Basalzellencarcinom mit Metastasierung in Nieren and Knochenmark

    Dermatol Wochenschr

    (1935)
  • GW Binkley et al.

    Basal-cell epithelioma metastasizing to lymph nodes

    Arch Dermatol

    (1962)
  • AL Bogoslavsky et al.

    Skin basalioma with massive metastasing into the skeleton

    Vopr Onkol

    (1957)
  • B Bohne

    Die Entartungspotenz der Basaliome

  • DM Borel

    Cutaneous basosquamous carcinoma

    Arch Pathol

    (1973)
  • JMHM Borghouts et al.

    Metastasering van een basocellulair huidcarcinoom

    Ned Tijdschr Geneeskd

    (1966)
  • P Caccialanza et al.

    Die Entwicklung des metatypischen Epithelioms. Beobachtung zweier klinischer Fälle

    Dermatol Wochenschr

    (1954)
  • WL Chien

    Basal cell carcinoma with metastases to bones and lungs

    Va Med

    (1966)
  • M Christensen et al.

    Metastatic basal cell carcinoma: A review of the literature and report of two cases

    Am Surg

    (1978)
  • CC Coleman et al.

    Surgical treatment of cancer of the nose

    Va Med

    (1963)
  • DF Coletta et al.

    Metastasizing basal cell carcinoma of the skin with myelophthisic anemia

    Cancer

    (1968)
  • CE Cornelius

    Bone. A site of metastatic basal cell carcinoma

    Arch Surg

    (1972)
  • ME Costanza et al.

    Metastatic basal cell carcinoma: Review report of a case and chemotherapy

    Cancer

    (1974)
  • L Cranmer et al.

    Basal cell carcinoma of skin metastatic to bone

    Arch Dermatol

    (1970)
  • HJ Crawford et al.

    Metastasising basal-cell carcinoma

    J Pathol Bacteriol

    (1964)
  • MC Curry et al.

    Giant basal cell carcinoma of the back

    Arch Dermatol

    (1975)
  • S Dahlgren et al.

    Metastasizing basal-cell carcinoma

    Acta Pathol Microbiol Scand

    (1963)
  • J Darier et al.

    L' épithéliome pavimenteux mixte et intermédiaire

    Ann Dermatol Syph (Paris)

    (1922)
  • S De Navasquez

    Metastasizing basal cell carcinoma

    J Pathol Bacteriol

    (1941)
  • EA Elias et al.

    The enzyme histochemistry of metastasising basal cell carcinoma of the skin

    J Pathol

    (1980)
  • CW Finnerud

    Metastatic basal cell carcinoma from the skin

    JAMA

    (1924)
  • P Fitzpatrick

    Metastasizing basal cell carcinoma

    Can Med Assoc J

    (1979)
  • NC Foot

    Adnexal carcinoma of the skin

    Am J Pathol

    (1947)
  • JA Fordyce

    Cancer of the skin

    J Cutan Genito-Urin Dis (New York)

    (1902)
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