Abstract
Basal cell carcinoma (BCC) is the most common cancer affecting humans worldwide and its ?annual incidence continues to increase. Ninety-five percent of sporadic cases are diagnosed in ?patients over the age of 50. BCC portends a notoriously favorable prognosis in most patients, ?with morbidity limited to localized destruction and high rates of recurrence. A 38-year-old ?fisherman with a remote history of BCC involving the cheek treated over 10 years prior was ?referred to our institution for acutely worsening back pain. He endorsed a one-year history of ?midback pain accompanied by multifocal, radiating paresthesia, decreased voluntary control of ?the lower extremities, and psychiatric disturbances. Imaging studies revealed multiple lytic ?bone lesions and spinal cord compression. Differential diagnosis included osteomyelitis, ?hemangiomas, Langerhans cell histiocytosis, multiple myeloma, and metastasis of an unknown ?primary. Chest x-ray and routine laboratory studies were unremarkable. FNA and core biopsy of ?the bone lesions demonstrated nests of small basaloid cells with peripheral palisading. Tumor ?cells stained positive for Bcl2, BerEP, and p63 and negative for SMA and EMA. These findings ?were consistent with BCC. Metastatic basal cell carcinoma (mBCC) is an unexpected outcome ?affecting less than one percent of patients with a known primary and predominantly involves ?regional lymph nodes. Reports of isolated bone involvement and spinal cord compression are ?rare. In the cases of mBCC that we identified in the literature, patients presented with massive ?primary lesions on the trunk that had been present for years and that were often still present at ?the time of diagnosis. Our case uniquely illustrates that a historically resected primary lesion ?may cause distant metastasis after a decade. The chronicity of symptoms is a helpful clue to the ?diagnosis. We attribute the patients chronic back pain to BCCs slow-growing nature.?
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