Moradi Hazhir, Karavan Negar, Kalantari Forough, Kalantari Elham
Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Case Rep Med. 2025 Sep 10;2025:8239242. doi: 10.1155/carm/8239242. eCollection 2025.
Basal cell carcinoma (BCC) is the most common cutaneous malignancy, characterized by slow progression and a low propensity for metastasis. Metastatic basal cell carcinoma (mBCC) occurs in fewer than 0.1% of the cases, most frequently involving the lungs, lymph nodes, or bones. Although rare, mBCC is associated with poor prognosis and presents unique diagnostic and therapeutic challenges. We report a 77-year-old male with a remote history of multiple head-and-neck BCCs, including aggressive histologic subtypes (basosquamous and micronodular), treated predominantly with Mohs surgery; the margin status varied across procedures (some tumor free and some positive). Ten years after the initial lesion, the patient developed progressive dyspnea and was found to have bilateral pulmonary nodules on chest CT. PET/CT demonstrated increased FDG uptake, and a CT-guided biopsy of the right lung nodule confirmed mBCC. There was no evidence of local recurrence at the original excision sites. p16/HPV studies were not performed on the prior cutaneous primaries. This case highlights the potential for delayed pulmonary metastasis in BCC, even years after apparently curative treatment. The absence of local recurrence and the bilateral lung involvement suggest hematogenous spread. Clinicians should remain vigilant for metastatic disease in patients with a history of high-risk BCC, particularly when new pulmonary symptoms arise. Imaging and immunohistochemistry are critical for diagnosis, and early detection may improve therapeutic outcomes in this rare and aggressive manifestation. In this patient, the presence of aggressive histologic subtypes and prior positive margins likely increased metastatic risk.
基底细胞癌（BCC）是最常见的皮肤恶性肿瘤，其特点是进展缓慢且转移倾向低。转移性基底细胞癌（mBCC）的发生率不到0.1%，最常累及肺、淋巴结或骨骼。尽管罕见，但mBCC预后较差，且在诊断和治疗上面临独特挑战。我们报告一名77岁男性，有多次头颈部BCC的既往史，包括侵袭性组织学亚型（基底鳞状和微结节型），主要接受莫氏手术治疗；各次手术的切缘状态不一（有些无肿瘤，有些阳性）。初始病变发生十年后，患者出现进行性呼吸困难，胸部CT发现双侧肺结节。PET/CT显示FDG摄取增加，右肺结节的CT引导下活检确诊为mBCC。原切除部位无局部复发证据。之前的皮肤原发性肿瘤未进行p16/HPV研究。该病例突出了BCC发生延迟肺转移的可能性，即使在看似治愈性治疗多年后。无局部复发且双侧肺受累提示血行播散。临床医生应对有高危BCC病史的患者的转移性疾病保持警惕，尤其是出现新的肺部症状时。影像学和免疫组化对诊断至关重要，早期发现可能改善这种罕见且侵袭性表现的治疗结果。在该患者中，侵袭性组织学亚型的存在以及既往切缘阳性可能增加了转移风险。
