Samia Arthur M, Nenow Joseph M, Boyer Philip
Dermatology, University of Florida, Gainesville, USA.
Internal Medicine, Indiana University, Indianapolis, USA.
Cureus. 2022 Mar 17;14(3):e23273. doi: 10.7759/cureus.23273. eCollection 2022 Mar.
Basal cell carcinoma (BCC) is the most common malignancy worldwide and has one of the most favorable prognoses due to its tendency to remain local. Clinical presentation with rare distant metastases significantly increases morbidity and mortality. Historically, no effective therapies have existed for locally advanced or metastatic BCC. Recent research highlights the possibility of treating patients with advanced and metastatic BCC with hedgehog pathway inhibitors, such as vismodegib or sonedigib. We present the case of a 62-year-old male with a history of a large left shoulder lesion, which was diagnosed as a nodulocystic BCC following biopsy and histopathologic examination. The primary lesion was managed with surgical excision, and his ensuing metastatic disease was treated with vismodegib, sonedigib, tumor debulking, and radiation therapy. Magnetic resonance imaging and computed tomography of the chest revealed probable metastases to the apical segment of the left upper lobe and thoracic spine, leading to spinal stenosis and probable cause of the patient's ataxia and paresthesias. Due to the ability of BCCs to transform during metastasis, it is impossible to identify the nature of metastatic lesions (i.e., basaloid, squamous, or hybrid) without biopsy. In this case report, we review the etiologies, typical demographics, presentation patterns, and treatment regimens for metastatic BCC and the possibility of metastatic disease transforming to squamous or hybrid variants.
基底细胞癌（BCC）是全球最常见的恶性肿瘤之一，因其倾向于局限于局部，故而预后相对较好。罕见远处转移的临床表现会显著增加发病率和死亡率。从历史上看，对于局部晚期或转移性基底细胞癌不存在有效的治疗方法。近期研究凸显了使用刺猬通路抑制剂（如维莫德吉或索尼德吉）治疗晚期和转移性基底细胞癌患者的可能性。我们报告一例62岁男性病例，其左肩有一较大病变史，活检及组织病理学检查后诊断为结节囊肿性基底细胞癌。原发灶通过手术切除进行处理，随后其转移性疾病接受了维莫德吉、索尼德吉、肿瘤减瘤及放射治疗。胸部磁共振成像和计算机断层扫描显示左上叶尖段和胸椎可能发生转移，导致椎管狭窄，这可能是患者共济失调和感觉异常的原因。由于基底细胞癌在转移过程中会发生转变，因此在未进行活检的情况下无法确定转移灶的性质（即基底样、鳞状或混合型）。在本病例报告中，我们回顾了转移性基底细胞癌的病因、典型人口统计学特征、表现模式、治疗方案以及转移性疾病转变为鳞状或混合型变体的可能性。
