Abstract Introduction Basal Cell Carcinoma is a common form of skin cancer that affects 3.6 million patients each year (1). It is mostly considered an indolent cancer with low rates of metastasis (0.0028 to 0.55 percent) (3). The most common sites are regional lymph nodes, bone, lung, and liver (3). Pathogenesis is often due to ultraviolet radiation induced mutations in the Hedgehog Signaling Pathway (Nehal). We present a rare case of recurrent basal cell carcinoma with metastasis to the lung. Case Presentation An 84-year-old female presented with new onset of wheezing and dyspnea. She had a history of locally invasive basal cell carcinoma to cervical lymph nodes six years prior, treated with resection, neck dissection and adjuvant radiation. The patient developed a local recurrence three years later and underwent a partial parotidectomy A chest CT showed a 3cm right hilar mass with partial right upper lobe collapse. Flexible bronchoscopy demonstrated complete occlusion of the right upper lobe with narrowing of the bronchus intermedius and abnormal edematous mucosa. Endobronchial ultrasound with transbronchial needle aspiration of the hilar mass showed neoplastic cells morphologically similar to the prior resection specimens. Immunophenotyping (Ber-EP4 and p40, weakly positive for BCL-2) was consistent with metastatic basal cell carcinoma. Discussion The main treatment for localized and locally advanced basal cell carcinoma involves surgery and radiation. In distant metastatic disease treatment options are more limited. Targeted therapies such as Vismodegib, inhibit the hedgehog signaling pathway by binding to a transmembrane G protein coupled receptor called Smoothened protein (SMO) (2). This blocks GLI transcription factors from activating cellular proliferation. Despite these therapies, prognosis remains poor and complete response rates are 5% (2). While rare, metastatic basal cell carcinoma should be considered in patients with prior history of locally advanced basal cell carcinoma. References: Krakowski, Andrew C., et al. “Advanced basal cell carcinoma: What dermatologists need to know about diagnosis.” Journal of the American Academy of Dermatology, vol. 86, no. 6, June 2022, https://doi.org/10.1016/j.jaad.2022.03.023. Nehal, Kishwer, and Christopher Bichakjian. “Update on Keratinocyte Carcinomas.” The New England Journal of Medicine, U.S. National Library of Medicine, 25 July 2018, pubmed.ncbi.nlm.nih.gov/30044931/. Rubin, Adam I., et al. “Basal-cell carcinoma.” New England Journal of Medicine, vol. 353, no. 21, 24 Nov. 2005, pp. 2262-2269, https://doi.org/10.1056/nejmra044151. This abstract is funded by: None
Musgrove et al. (Fri,) studied this question.