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Case Reports

Abstract

A seventy-year-old male was hospitalized for a myocardial infarction, with a chest X-ray revealing a solitary lung nodule. A CT-guided biopsy performed at another institution diagnosed a primary basaloid squamous cell carcinoma of the lung. Weeks later, the patient visited an oncologist who, upon asking the patient to remove his hat, discovered an 8.0 × 6.0 cm scalp tumor not identified during his four-day hospital stay. A biopsy of the scalp tumor revealed basal cell carcinoma, nodular type. Review of the outside CT-guided lung biopsy showed absence of SOX-2 expression, confirming metastatic basal cell carcinoma and excluding basaloid squamous cell carcinoma. Following daily treatment with 200 mg of sonidegib, the lung tumor decreased from 2.1 cm to 1.6 cm with only a 2.0 cm scalp eschar remaining. Metastatic basal cell carcinoma is extremely rare, with an estimated incidence between 0.0028% and 0.55%. It occurs more frequently in males with large, recurrent primary tumors or perineural/angiolymphatic invasion. The most common primary sites are the head and neck, with metastases to lymph nodes, lungs, and bones. Historically, prognosis was grim, with 1- and 5-year survival rates of 20% and <10%, respectively. However, outcomes appear to be improving with the advent of hedgehog pathway inhibitors such as sonidegib.