|Year : 2021 | Volume
| Issue : 1 | Page : 27-29
Metastatic basal cell carcinoma
Isha Shah, Aastha Shah, U Suryanarayan
Department of Radiotherapy, GCRI, Ahmedabad, Gujarat, India
|Date of Submission||02-Dec-2020|
|Date of Acceptance||24-Dec-2020|
|Date of Web Publication||12-Feb-2021|
Dr. Isha Shah
Department of Radiotherapy, GCRI, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
Basal cell carcinoma (BCC) is the most frequent, slow–growing, and potentially locally aggressive neoplasm of skin that rarely metastasizes. Incidence of BCC is high, but metastatic BCC is extremely rare. When metastasis develops in this group of disorder, it generally occurs to the lymph nodes, lungs, and bones. Metastasis to brain is extremely rare among all these. Herein, we report a case of BCC primarily of head-and-neck region which over a period of time metastasized to the brain. In this case, solitary brain metastasis was operated and whole brain radiotherapy was offered. Although BCC itself being a common, the case of metastasis of BCC is a very rare as a disease entity and rarest because of the metastatic involvement of the brain.
Keywords: Basal cell carcinoma, brain metastasis, metastatic basal cell carcinoma
|How to cite this article:|
Shah I, Shah A, Suryanarayan U. Metastatic basal cell carcinoma. J Radiat Cancer Res 2021;12:27-9
| Introduction|| |
Basal cell carcinoma (BCC) is a slowly progressive and poorly metastasizing carcinoma of skin. It is the most common low-grade carcinoma accounting for 80% of nonmelanometous carcinoma of skin. Epidemiology suggests that BCC can develop anywhere on the body surface, especially on the exposed areas of the head-and-neck region, with high propensity for local recurrence. Despite such high incidence of BCC, metastatic BCC is extremely rare and is seen in 0.0028%–0.55% with approximately 230 cases reported till now in world literature review. Almost 85% of metastatic BCC arise from primary lesions in the head-and-neck region and is less frequent from BCC over back and extremities. Metastatic BCC typically occurs in a middle-aged men having BCC of long duration, and the spread in order of frequency is usually to lymph nodes, lungs, bones, skin. and to other sites.
This case in discussion has been chosen due the unusual metastasis of the BCC to the brain.
| Case Report|| |
A 75-year-old male presented to our institute with a history of wide local excision and primary closure of swelling over the left side of neck 2 years back.
Histopathology of specimen revealed BCC of 1.7 cm in a greatest dimension.
Closest resection margin was 0.3 cm away from tumor. Perineural invasion and lymphovascular invasion were not seen. Disease-free survival was for 2 years then patient developed complaints of weakness of left upper and lower limb for 15 days.
Magnetic resonance imaging (MRI) brain was done which showed 3.8 cm × 2.9 cm × 3.3 cm lesion in the right frontal lobe-temporal lobe, right thalamocapsular regions, and left cerebellar hemisphere. Mass effect and midline shift were present. Possibility of metastasis was suggested. The patient was further evaluated and underwent right frontal craniotomy with complete excision of right frontal space-occupying lesion, and histopathology was suggestive of metastatic BCC which was further confirmed by immunohistochemistry, which showed cytokeratin (CK) 5/6 weakly positive, P63 negative, CK7 focally positive, EMA and CD10 negative, carcinoembryonic antigen only focally positive, and GCDFP 15 negative which was further confirming the diagnosis of metastaic BCC as shown in [Figure 1] and [Figure 2].
|Figure 1: Slide from postoperative brain histopathology suggestive of metastatic basal cell carcinoma|
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|Figure 2: Slide from postoperative brain histopathology showing metastatic tumor cells|
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We planned whole brain radiation to a total dose of 30 Gray in 10 fractions for this patient.
| Discussion|| |
BCC arises from epidermal layer of skin and its appendages and is the most common skin cancer. BCC is the most frequent, slow–growing, and potentially locally aggressive skin neoplasm. Although they are commonly seen in the exposed area of the head-and-neck region, about 10% of all BCCs are located on the trunk and <1% of cases have been reported to occur in the unexposed areas of the genitalia. Although BCC is frequently regarded as a low-grade malignancy, sometimes it is extremely aggressive. The BCCs from which metastasis arises are commonly large, facial, locally invasive and destructive, ulcerated, long-standing, treatment-resistant, and histologically aggressive. The criteria for diagnosing metastasizing BCC are primary tumor localized to the skin and not mucous membranes, metastases in the lymph nodes or viscera, site distant to the primary, and not related to simple extension and histologic features of both the primary tumor and the metastases typical of BCC, without signs of epidermoid differentiation. There is 2% incidence of metastasis for tumors larger than 3 cm in diameter. The incidence increases to 25% for tumors larger than 5 cm in diameter and 50% for tumors larger than 10 cm in diameter. Increased tissue invasion and extension of the tumor into adjacent anatomical structures also enhance metastatic potential. Immunosuppression and evidence of perineural spread or invasion of blood vessels have also been implicated as risk factors for metastasis. Lymphatic and hematogenous spread is equally prevalent, with lymph nodes, lungs, and bone being the most common sites of metastases. The prognosis is poor with a mean survival of 1 year.
| Conclusion|| |
Solitary brain metastasis is extremely rare in case of BCC. We reported a case of metastatic BCC which is a rare disease, presenting in an extremely rare site at brain. The diagnosis of metastasis in brain in a treated case of BCC was confirmed by clinical suspicion, MRI, postoperative histopathological examination, and immunohistochemistry. The patient was operated for solitary brain metastasis and followed by whole brain radiotherapy given. In a world literature review, solitary brain metastasis is extremely rare in a case of BCC.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Vu A, Laub D Jr. Metastatic basal cell carcinoma: A case report and review of the literature. Eplasty 2011;11:ic8.
Mehta KS, Mahajan VK, Chauhan PS, Sharma AL, Sharma V, Abhinav C, et al
. Metastatic basal cell carcinoma: A biological continuum of basal cell carcinoma? Case Rep Dermatol Med 2012;2012:157187.
Farmer ER, Helwig EB. Metastatic basal cell carcinoma: A clinicopathologic study of seventeen cases. J Am Acad Dermatol 1991;24:715-9.
Hayes AJ, Clark MA, Harries M, Thomas JM. Management of in-transit metastases from cutaneous malignant melanoma. Br J Surg 2004;91:673-82.
Talmi YP, Horowitz Z, Wolf M, Kronenberg J. Delayed metastases in skin cancer of the head and neck: The case of the “known primary”. Ann Plast Surg 1999;42:289-92.
von Domarus H, Stevens PJ. Metastatic basal cell carcinoma. Report of five cases and review of 170 cases in the literature. J Am Acad Dermatol 1984;10:1043-60.
Ducic Y, Marra DE. Metastatic basal cell carcinoma. Am J Otolaryngol 2011;32:455-8.
[Figure 1], [Figure 2]