SESSION TITLE: Lung Cancer Cases - Student/Resident
SESSION TYPE: Student/Resident Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 03:15 PM - 04:15 PM
INTRODUCTION: Basal Cell carcinoma (BCC), unlike other skin malignancies, rarely metastasizes with an incidence rate ranging between 0.0028 and 0.55%. Less than 400 cases have been reported in the literature over the past 120 years.We present a rare case of BCC that had recurrent metastasis in the lung over a period of 17 years.
CASE PRESENTATION: The patient is an 89 year old male with a history of BCC of the forehead resected 17 years ago. Eight years later, he presented with solitary pulmonary nodule confirmed to be metastatic BCC. He underwent wedge resection of the right lower lobe followed by radiation due to local recurrence. He now presented with numbness of the right hand worsened by deep inspiration. The patient denied fever, cough, sputum production, hemoptysis, chest pain or shortness of breath. His other medical history included hypertension and COPD.Chest X-ray showed right middle lobe infiltrate and elevated hemi diaphragm. CT scan of the chest without contrast demonstrated, right middle lobe pneumonia and a 2.5cm nodule in the left apex. He was treated with antibiotics and a subsequent CT chest with contrast confirmed only a spiculated mass in the left apex. CT scan of the abdomen, pelvis and brain was unremarkable.PET-CT scan showed a hypermetabolic 2.3cm apical nodule with irregular border and SUV of 12.6, suspicious for a primary lung neoplasm. He had a CT guided biopsy and frozen section demonstrated malignant cells. Immunohistochemistry confirmed the lesion to be a metastatic BCC, morphologically similar to the primary BCC diagnosed 17 years.
DISCUSSION: BCC is usually a slow growing, locally destructive lesion with excellent prognosis. On the other hand, metastatic BCC is very aggressive and carries a poor prognosis. The median time for metastasis from onset of initial lesion is about 9 years.The size of the initial tumor and local recurrence appear to predict the likelihood of metastatic disease.The metastasis can be either regional (RM) or distant (DM). Lung is a common site for distant metastasis .The median survival with DM is 24 months in comparison to 87 months with RM. This particular patient however survived for more than 8 years since his metastatic disease was first diagnosed.
CONCLUSIONS: Metastatic BCC is a rare entity. Although historically associated with a poor prognosis, the natural history of metastatic BCC might not be as grim as reported in the literature. To our knowledge, this is the longest surviving patient with metastatic BCC ever reported. More research is necessary to better characterize favorable factors in metastatic BCC and find out the sub-group of patients who would greatly benefit from aggressive therapy.
Reference #1: von Domarus H,. Stevens PJ. Metastatic basal cell carcinoma. Report of five cases and review of 170 cases in the literature. J Am Acad Dermatol. 1984 Jun;10(6):1043-60.
DISCLOSURE: The following authors have nothing to disclose: Biplab Saha, Kristin Fless, Sunil Sapru
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