von Domarus H, Stevens P J
J Am Acad Dermatol. 1984 Jun;10(6):1043-60. doi: 10.1016/s0190-9622(84)80334-5.
We report five cases of metastasizing basal cell carcinoma. The incidence of metastases in all patients with basal cell carcinomas who had surgery in the same period was 0.1%. There was no squamous differentiation in the histology of any of the primary lesions, but we found some squamous differentiation in a late recurrence in one patient and in the metastases in two patients. All other histologic features were identical in both the primary tumor and in the metastases. Perineural spread and blood vessel invasion were evident in the primary tumor and/or recurrence of three of the five patients and may be important pointers to possible recurrence and metastasis. Of 205 cases of metastasizing basal cell carcinomas mentioned in the literature, we accepted and evaluated 170 cases of tumors of the skin with histologic proof of metastasis. The male-to-female ratio was 2:1, median age at onset of primary tumor, 45 years, median interval between onset of tumor and first sign of metastasis, 9 years, median age at first sign of metastasis, 59 years, and median survival after first sign of metastasis, only 8 months. The site of the primary tumors is similar to that in nonmetastasizing basal cell carcinoma. Metastatic spread is most often to lymph nodes, lungs, and bones with lymphogenic and hematogenic spread equally frequent. Age or sex of the patient seemed to have no influence on survival or way of metastatic spread. As metastasis of basal cell carcinoma is extremely rare (1 in 1,000 to 35,000), many authors sought or postulated histologic "degeneration" into a squamous cell carcinoma, but no such unequivocal evidence has ever been found. Areas of squamous differentiation were reported in less than 15% of both primary and metastatic lesions of metastasizing basal cell carcinoma. The mode of metastatic spread and the characteristics of the histology make it rather unlikely that metastasis of a basal cell carcinoma is due to a change toward squamous cell carcinoma.
我们报告了5例转移性基底细胞癌。同期接受手术治疗的所有基底细胞癌患者的转移发生率为0.1%。所有原发性病变的组织学检查均未发现鳞状分化，但我们在1例患者的晚期复发灶以及2例患者的转移灶中发现了一些鳞状分化。原发性肿瘤和转移灶的所有其他组织学特征均相同。5例患者中有3例的原发性肿瘤和/或复发灶出现神经周围扩散和血管侵犯，这可能是提示可能复发和转移的重要指标。在文献中提及的205例转移性基底细胞癌病例中，我们接受并评估了170例有组织学转移证据的皮肤肿瘤病例。男女比例为2:1，原发性肿瘤发病的中位年龄为45岁，肿瘤发病至首次出现转移迹象的中位间隔时间为9年，首次出现转移迹象时的中位年龄为59岁，首次出现转移迹象后的中位生存期仅8个月。原发性肿瘤的部位与非转移性基底细胞癌相似。转移最常发生于淋巴结、肺和骨，淋巴道转移和血行转移的频率相同。患者的年龄或性别似乎对生存或转移途径没有影响。由于基底细胞癌的转移极为罕见（1/1000至1/35000），许多作者寻找或推测其组织学“退变”为鳞状细胞癌，但从未发现如此明确的证据。在转移性基底细胞癌的原发性和转移性病变中，报告有鳞状分化区域的病例均少于15%。转移方式和组织学特征表明，基底细胞癌的转移不太可能是由于向鳞状细胞癌的转变所致。
