Metastatic basal cell carcinoma: A clinicopathologic study of seventeen cases

Abstract

Basal cell carcinoma is a common cutaneous neoplasm that rarely metastasizes. We studied the clinical and pathologic features of 17 patients with metastatic basal cell carcinoma as recorded in the files of the Armed Forces Institute of Pathology (AFIP). Sixteen of the patients were male, and as far as it could be determined, all were white. The most frequent site of metastasis was lung (9 cases), followed by bone (9, lymph nodes (4), liver (3), spleen (l) , and adrenal gland (1). Thirteen of the patients had metastatic lesions involving only one organ system. Mean survival time after metastasis was 1.6 years. Features of metatypical (basosquamous) basal cell carcinoma were common in the primary and recurrent tumors, and metastatic lesions generally had a metatypical or adenoid pattern. Two of the five bony metastases demonstrated shadow cells characteristic of pilomatrixoma. The metatypical pattern of a basal cell carcinoma is a feature of an aggressive lesion with the ability to metastasize. Cancer 46:748-757. 1980. N 1827, ARTHUR JACOB, an Irish surgeon, provided I the first clinical description of a basal cell carcinoma when he detailed findings of extensive rodent ulcers on the faces of 3 patients.14 Cecil Beadles 67 years later reported the first case of a metastatic rodent ulcer' in a 46-year-old man with a primary lesion on the face and metastases to a submandibular lymph node. Beadles provided for the first time a histologic description of the metastatic lesion. In 1900, Krompecher began publishing a series of papers on the detailed histologic features of basal cell carcinomas,lS which he believed were derived from the basal cells of the epidermis. Over the past three-quarters of a century, numerous case reports and reviews of the literature have been published on metastatic basal cell carcinomas. The questions generally asked have been as follows: 1. What is the incidence? 2. What are the demographic and clinical features of the patients? 3. the response to therapy? 4. What are the pathologic features? and 5. What are the conditions that allow or promote the occurrence of a metastatic lesion? We have studied 17 cases of metastatic basal cell carcinoma from the files of the AFIP. Our purpose was to find answers to all of the above except the question dealing with incidence. Since material submitted to AFIP is selected and not random, a true incidence could not be obtained. Recent reviews of the literature, however , have estimated the incidence to range from 0.028% to 0.55% depending upon the population These figures reinforce the general concept that metas-tasis from a basal cell carcinoma is a relatively rare event. Materials and Methods Twenty-five cases were available for study from the files of the AFIP, submitted from civilian and military sources. They were coded under the following categories: metastatic basal cell carcinoma (20 cases), metastatic adnexal carcinoma (2), basal cell carcinoma of bone and muscle (l), mixed carcinoma of lung (l), and unclassified carcinoma (1). Follow-up of each pati...

BerEp4, Cytokeratin 14, and Cytokeratin 17 Immunohistochemical Staining Aid in Differentiation of Basaloid Squamous Cell Carcinoma From Basal Cell Carcinoma With Squamous Metaplasia

“…The classification and nomenclature of these tumors in the literature has been controversial. The term basosquamous carcinoma has been used by some to describe BCC with squamous metaplasia as well as a prominent stromal proliferation, 17,18 although others apply the same name to collision tumors in which a typical BCC is identified adjacent to SCC. 19 Metatypical BCC has been used synonymously with basosquamous carcinoma by some authors, 6,[18][19] and by others, it is used to describe tumors that have overlapping features of both squamous and basal cell carcinomas, 20 which is how the term is used at our institution.…”

“…The term basosquamous carcinoma has been used by some to describe BCC with squamous metaplasia as well as a prominent stromal proliferation, 17,18 although others apply the same name to collision tumors in which a typical BCC is identified adjacent to SCC. 19 Metatypical BCC has been used synonymously with basosquamous carcinoma by some authors, 6,[18][19] and by others, it is used to describe tumors that have overlapping features of both squamous and basal cell carcinomas, 20 which is how the term is used at our institution. Regardless of the specific nomenclature, there is evidence that BCCm may be more clinically aggressive than classic BCC, [21][22][23][24] citing more aggressive histologic features, such as greater infiltration, more mitoses, increased cytologic atypia, 21 recurrence rates of 10%, 20 and rates of metastases as high as 7.4%, 19 compared with 0.55% for typical BCC.…”

Malignant Transformation in Skin is Associated with the Loss of T-Cadherin Expression in Human Keratinocytes and Heterogeneity in T-Cadherin Expression in Tumor Vasculature

“…BSCC is not widely discussed in the literature and little attention has been paid to this subtype in recent comprehensive reviews of cutaneous SCC (Cassarino et al, 2006a;Cassarino et al, 2006b). The importance of diagnostics of these tumors is based on the fact that BSCC pathological pattern is associated with a more aggressive behavior and a significantly higher incidence of metastasis than BCC or SCC (Banks et al, 1992;Farmer & Helwig, 1980;Smith & Irons, 1983;Winzenburg et al, 1998). The diagnosis of BSCC is currently based on histological criteria, initially proposed by Wain and coauthors (Wain et al, 1986).…”

Lectin-binding sites in basal cell epitheliomas and carcinomas.

“…They are slow-growing and rarely metastasize. Approximately 90% of them occur in the head and neck area, mostly in the facial skin (7,23). Since Krompecher first noted the histopathology of BCE and BCC, possible origins of this neoplastic disease were suggested to be the basal layer cells of the epidermis, the outer root sheath, sebaceous glands, sweat gland, and multicentric origins (26).…”