491 Metastatic Micronodular BCC – a Multimodal Approach and Reconstruction in the MDT Setting

Abstract Introduction BCC is the most common cancer. Metastatic BCC is limited to a small percentage 1% of cases. This is usually local nodal invasion rather than true metastasis. BCC is deemed low risk with cure rates of 96% with predetermined margins. Case report We present a 55-year-old male with no significant past medical history who developed metastatic basal cell carcinoma (BCC) to the regional inguinal lymph nodes 5 years post complete excision of a micronodular/infiltrative BCC with perineural invasion to the lower leg. CT chest, abdomen and pelvis showed a left groin mass invading the sartorius muscle and MRI pelvis showed encasement of left femoral artery and no evidence of distant metastases. The patient underwent ilio-inguinal dissection and resection of common femoral artery with Dacron graft reconstruction covered with sartorius muscle flap. The photos show a large soft tissue defect post-resection which was reconstructed using perforator-based flap containing multiple perforators based on lateral femoral circumflex artery. The patient then completed adjuvant radiotherapy 50Gy/25# over 5 weeks. Conclusions Metastatic BCC in a young fit patient requires radical surgery and adjuvant radiotherapy. Complex reconstruction was planned within the MDT setting resulting in limb salvage, restoration of form, function and normal gait. Learning points include looking for metastasis in high-risk subtypes of BCCs. It is important to manage these rare cases with an MDT approach and emphasize patient education regarding recurrence and metastatic risk post-diagnosis and at time of discharge.