A three-case review of metastatic basal cell carcinoma

Victoria, British Columbia - Meta-static basal cell carcinoma (MBCC), albeit a rare complication of basal cell carcinoma (BCC), usually takes an unpredictable and aggressive course and is earmarked by high morbidity and high mortality rates.

Examining and discerning diagnostic considerations for primary and metastatic lesions of MBCC may reveal a requisite for early intervention with aggressive treatment modalities, which may allow both a better prognosis and survival of patients with MBCC.

Patricia Ting, B.Sc., from the University of Calgary faculty of medicine, Alberta, Canada, and her colleagues presented their results of a three-case study of MBCC at the annual meeting of the Canadian Dermatology Association here in June.

"The wide range of percentages may be attributed to the data sources and patient populations studied, since numbers are highly variable between academic centers, surgical facilities, dermatology practices, pathology records and reporting legislation," says Ms. Ting, one of the principal investigators.

Three patientsThe researchers examined three patients (two male and one female), 29, 57 and 47 years of age at disease onset, with intervals to metastasis recorded at 22, 11 and 4 years, respectively.

The initial BCC in the 29-year-old patient was located on the posterior hair line, and had metastasized to the cervical lymph nodes. The 57-year-old patient presented with BCC on the left side chin and showed MBCC on the mid-anterior neck, mediastinal lymph nodes and lungs. The third patient (female) had a left lower orbital rim BCC, with MBCC to the right maxillary periosteum, parotid and carotid lymph nodes, ribs and neck of right femur.

Patient 1 is presently three years post-metastasis and disease-free after undergoing resection, reconstruction and modified Mohs surgery. Patient 2 died in May 2004, and survived seven years with MBCC after CO₂ laser treatments and 14 resections.

Patient 3 is two years post-metastasis with aggressive disease after undergoing a 2x resection and reconstruction.

"Similar to risk factors associated with other types of skin cancers, a fair complexion, Fitzpatrick skin type I and II, prior history of excessive sun exposure, significant degree of actinic damage and personal or family history of skin cancer may all contribute to the development of MBCC," affirms the investigator.

Most frequent in malesMBCC is twice as frequent in males, most often involving dissemination to the regional lymph nodes (40 percent to 83 percent) and hematogenous spread to the lungs, bones (20 percent to 28 percent) and skin (10 percent to 17 percent). Of the 260 reported cases of MBCC in literature, almost all cases occurred in patients with fair complexions, and only five cases in blacks.

Ms. Ting and her team suggested that, "Large, recurrent primary BCC, especially those of long duration, are an indication for more aggressive initial treatment to prevent recurrence and further progression of BCC infiltration and metastases."

Poor prognosisPatients with MBCC have a poor prognosis with an estimated average survival of eight months, less than 20 percent surviving more than a year, the longest recorded survival being 25 years after diagnosis.