Track: Clinical Studies

Topic: Neoplasia,Carcinogensis,Tumor Biology

Abstract:

Background: Basal Cell Carcinoma (BCC), the most prevalent skin cancer worldwide, is strongly linked to sunlight exposure and typically exhibits low metastatic potential, with metastasis rates ranging between 0.0028% and 0.55%. Despite its rarity, BCC with bone metastasis (mBCC) poses significant clinical challenges.

Methods: This review compiles published cases of mBCC, analyzing patient demographics, tumor characteristics, histological subtypes, and treatment modalities to delineate patterns and outcomes.

Results: Out of 123 cases reviewed, 64 were aged over 60, while 59 were 60 or younger. The cohort included 76 males and 45 females. At initial diagnosis, 36 patients had tumors larger than 2 cm. Histologically, the subtypes identified were 15 basosquamous, 25 metatypical, 24 morphea, 17 infiltrative, 14 nodular, with 24 cases showing intravascular invasion. There were also rare presentations including 3 superficial, 3 solid, 3 with squamous differentiation, and 3 with keratinization. The main treatments administered were surgery (89 cases), chemotherapy (55 cases), immunotherapy (20 cases), and radiotherapy (19 cases).

Conclusion: BCC with bone metastasis, although infrequent, demands significant attention due to its management complexity. Histological subtypes such as infiltrative, sclerosing, morphea form, basosquamous, and micronodular are associated with aggressive behavior and a higher metastatic risk. Recognition of symptoms like bone pain or hypercalcemia is crucial for timely diagnosis. Given the aggressive potential of certain subtypes and their implications for treatment, a personalized management approach, informed by detailed histological and molecular profiling, is essential for optimizing outcomes in mBCC.

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Amir-Reza Khalili-Toosi, MD