Abstract
Objective
The purpose of this study is to review our series of metastatic basal cell carcinomas of the head and neck.
Study Design
A retrospective review was conducted for this study.
Methods
All cases of documented metastatic basal cell carcinomas arising from a primary within the head and neck region and presenting for treatment to one of the authors (Y.D.) were included in this review.
Results
Nine patients were available for review. Five patients had extension to but not transgression of the base of skull. Sites for metastatic disease included 4 lungs and 5 parotid glands. All metastatic lesions were treated with surgical excision, and 6 also received postoperative radiation therapy. No patient deaths from disease have been noted at an average follow-up of 4.7 years (range, 3–8.5 years). No evidence of further metastatic disease has been noted in any of these patients on follow-up.
Conclusions
Metastatic basal cell carcinoma arising from a head and neck primary is a rare entity. However, initial involvement of the skull base and/or dura by a basal cell carcinoma appears to warrant a complete metastatic workup and metastatic surveillance. When metastatic disease is discovered, it appears to be well treated by surgical resection with/without adjunctive radiation therapy. We do not favor chemotherapy for resectable basal cell carcinomas.
1
Introduction
Basal cell carcinoma represents the most common skin cancer in the Caucasian population. Metastatic disease arising from basal cell carcinomas in the head and neck region is exceptionally rare, occurring at an estimated rate of only 0.03% . The true incidence of metastatic basal cell carcinomas (MBCCs) may be higher, with underreporting arising because of rarity of diagnosis and lack of awareness on the part of clinicians . Less than 300 cases have been reported in the world literature to date, most consisting of case reports or case series of less than a handful of patients .
In 1894, Beadles reported a case of a so-called rodent ulcer deposit within lymphatic gland tissue. Later, Lattes and Kessler described the most widely accepted criteria for a diagnosis of MBCC to include the following: ( a ) the primary lesion and metastasis cannot be primarily squamous; ( b ) the primary tumor may not originate in salivary glands or mucous membranes, and ( c ) the metastatic nodules must be in lymph nodes or distinct from the primary tumor.
In this article, we will review our series of MBCC all of which arose from a primary extending to or transgressing the skull base.
3
Methods
All cases presented to one of the authors (Y.D.) who had documented MBCC per classic criteria as outlined by Lattes and Kessler and cases with a minimum follow-up of 3 years were reviewed. Demographic data, pathology, radiographic imaging, treatment, and follow-up data were all collected. Institutional review board approval was obtained for this study.
4
Results
A total of 9 patients were available for review as defined above. The male/female ratio was 5:4 with a mean age of 63.2 years at presentation (range, 42–72 years). The average primary lesion dimension was 10.4 cm (range, 5–22 cm). The average time to presentation/discovery of metastatic disease was 2.5 years (range, 0–4.2 years). Four patients had dural involvement, and one of these had focal brain parenchymal involvement. The remaining patients all had extension to but not transgression of the base of skull. Sites for metastatic disease included 4 lungs (3 solitary, single patient with 2 lung sites) and 5 parotid glands ( Figs. 1-3 ). The parotid gland lesions were metastatic to intraparotid lymph nodes. All cases were reviewed by at least 2 pathologists. All metastatic lesions were treated with surgical excision, and 6 also received postoperative radiation therapy. Local recurrence occurred in 2 patients who underwent further surgery and radiation. No patient deaths from disease have been noted at an average follow-up of 4.7 years (range, 3–8.5 years). No evidence of further metastatic disease has been noted in any of these patients on follow-up.
