Metastastatic basal cell carcinoma – A case report

The basal cell carcinoma (BCC) is the most common malignant skin tumor. It is characterized by a local-infiltrative and destructive growth, metastatic spread is extremely rare. Its rarest form is the sklerodermiform subtype. It shows spurs far over the macroscopic margins and due to its atypical aspect it is frequently misdiagnosed.

A 62 year old patient was presented with suspect lymph nodes of the right neck. The pathologic examination of one lymph node at first showed metastases of a low differentiated, partly basaloid squamous cell carcinoma. No primary tumor was found in the specimen acquired during diagnostic panendoscopy and tonsillectomy of both sides, which led to the diagnosis CUP N2b of the right side. A modified radical neck dissection of the right side and adjuvant radiotherapy were performed.

Furthermore, histologic examination of a resected skin tumor of the right auricle revealed a sklerodermiform BCC with atypical and typical areas. Together with the immunophenotype, the diagnosis of a metaplastic BCC was confirmed. The lymph node tissue was matched against the BCC tissue: due to similar morphologic properties and the strong consistent positivity for the marker BerEP4, the rare and unusual case of a metastatic BCC was diagnosed.

Metastatic spread of the BCC, which was formerly labelled as “semi-malignant”, is regarded as extremely rare. Nevertheless, metatypical BCC, which is categorized between squamous cell carcinoma and BCC at the cellular level , may present N+ situations. A thorough examination of the integument is always part of the primary tumor search.

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Publication History

Article published online:
10 June 2020