Purpose
While basal cell carcinoma (BCC) is a commonly diagnosed skin cancer, rates of metastasis are estimated to be as low as 0.0028 to 0.55%.1 Although rare, certain factors such as large tumour size and aggressive histological subtype are known to harbour increased risk.1 We present a case of a large, neglected BCC with pulmonary metastasis at time of presentation.
Method
A 51 year old male presented with a large, ulcerated axillary mass that had been present for several months. Biopsy showed a poorly differentiated carcinoma, favoured to be BCC. Staging imaging demonstrated extensive local invasion as well as a spiculated lung mass (with histology confirming metastasis). His previous medical history included a BCC excised from the left scapula 12 years prior, as well as a lifelong history of smoking.
Results
The patient proceeded to surgery for wide local excision, axillary dissection and ALT free flap reconstruction. Both the long thoracic nerve and thoracodorsal neurovascular bundle were encased in tumour and required to be sacrificed. A left lung upper lobectomy was performed by Cardiothoracics. At time of writing (two years later), the patient remains well with no evidence of disease recurrence.
Conclusion
While metastatic BCC is rare, it is important to remain aware of it as a possibility, particularly in BCC’s with high risk features. Early recognition and appropriate management is essential to improving outcomes.2
References