Abstract

Basal cell carcinoma is a malignant skin neoplasm arising from basal keratinocytes of the epidermis that rarely metastasizes. Though it is thought to be the most commonly diagnosed human malignancy, elucidating the true frequency at which BCC occurs proves challenging as nonmelanoma skin cancers (NMSC) are not often included in cancer registry data. Perineural invasion in primary nonmelanoma skin cancer categorizes a lesion as high risk for recurrence, but intravascular invasion is scarcely reported in the current body of literature and poses a prognostic dilemma. Reports of IVBCC are extremely limited, and there is no current consensus for optimal management. We present a case of a 48-year-old male who presented with a 1.7 centimeter erythematous papule with rolled borders and overlying telangiectasias adjacent to an atrophic scar on his left forehead which was diagnosed as nodular and infiltrative basal cell carcinoma on shave biopsy and subsequently excised. Paired immunohistochemical stains for CD31 and D2-40 highlighted the presence of basal cell carcinoma in blood vessels but not lymphatic vessels. At the time of presentation and follow up, the patient had no evidence of concurrent metastatic disease. Whether intravascular invasion confers the same increased risks in basal cell carcinoma as it does in other malignancies is understudied. To determine the incidence, risk, and prognostic implications of vascular invasion in BCC, more studies and reports are greatly needed. We document this case in order to contribute to the body of knowledge for possible future evidence-based management consensus.

Financial Disclosure:
No current or relevant financial relationships exist.