Track

Case Reports

Abstract

Background: Basal Cell Carcinoma (BCC) is the most common type of skin cancer, typically presenting as a semi-malignant tumor with very low metastatic potential. However, we report a rare case of cutaneous BCC with bone metastases in a 48-year-old male patient. Initially diagnosed three years prior without subsequent radiotherapy, the patient, an active smoker, presented with chronic ulceration on the left cheek and severe bone pain. Historical treatment included multiple surgeries and left eye evacuation due to tumor invasion but lacked systemic therapy.

Case presentation: Upon presentation at our institution, a large ulcerative lesion (8.5 x 10 cm) on the left cheek with infiltrative pattern and bone involvement was evident. Diagnostic imaging via CT scan revealed defects in the left facial area adjacent to the maxillary sinus, correlating with a history of extensive BCC surgical resections. No signs of edema, lytic or sclerotic lesions, or fractures were noted in surrounding soft tissues. A subsequent bone biopsy confirmed metastatic BCC with an infiltrative subtype, and widespread bone metastases were detected involving the spine, shoulders, ribs, and pelvis. The patient was commenced on palliative radiotherapy and systemic chemotherapy including Cisplatin, 5-fluorouracil, and zoledronic acid, which led to symptom relief and stabilization of the facial lesion.

Conclusion: This case underscores the importance of considering metastatic potential in atypical presentations of BCC and highlights the need for aggressive management strategies in such rare occurrences. Continuous follow-up has shown clinical stability with ongoing systemic therapy, indicating a responsive treatment protocol for this unusual manifestation of BCC.