Abstract Introduction Basal cell carcinoma (BCC) is the most common skin malignancy, typically characterized by local invasion with rare metastatic potential. When metastasis does occur, the lungs, bone, and lymph nodes are the most frequent sites, often associated with high morbidity and mortality. Here, we present the case of metastatic BCC to the lungs diagnosed using shape-sensing robotic assisted bronchoscopy (ssRAB), highlighting the role of advanced bronchoscopy in diagnosing rare pulmonary metastases. Case A 78-year-old woman with history of facial basal cell carcinoma with maxillary bone involvement post Mohs surgery, radiation, and subsequent facial reconstruction presented to our outpatient pulmonary facility for lung nodules. PET scan showed two enlarging hypermetabolic spiculated nodules along the right minor lung fissure and one medial left lower lobe nodule with traction along the pleura. The patient underwent ssRAB with radial endobronchial ultrasound (REBUS), transbronchial needle aspiration (TBNA), and cryobiopsies of the right-sided and left lower lobe nodules and 11L lymph node. Pathology confirmed metastatic basal cell carcinoma. Immunohistochemistry stains were positive for P40, weakly patchy positive for BER-EP4, and negative for TTF1, Cytokeratin 7, and S100. MYB-FISH was negative for adenoid cystic carcinoma. The patient was further evaluated by oncology and started on sonidegib, a Hedgehog signaling pathway inhibitor. Discussion Metastatic BCC is exceedingly rare, reported in 0.0028% to 0.5% of cases. Metastatic potential may be predicted by features such as BCC size (2cm), histological subtype, immunochemical features (p53, D2-40, Ki-67, BCL-2, SMA), and squamous differentiation. The head and neck region, particularly with recurrent or deep invasive lesions, is the most common origin for metastatic spread. This case highlights the evolving role of interventional pulmonology in diagnosing rare pulmonary metastases. Historically, pulmonary nodule sampling with traditional flexible bronchoscopy led to suboptimal diagnostic outcomes, often requiring invasive surgical lung biopsy as the next step. Guided techniques, including virtual bronchoscopy navigation, electromagnetic navigation bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy, improve diagnostic accuracy. Shape-sensing robotic assisted bronchoscopy (ssRAB) further enhances this capability by using real-time three-dimensional navigation, precise catheter articulation, and fiber-optic shape-sensing to access small, peripheral, and pleural-based lesions. In this case, ssRAB allowed for safe and accurate sampling of pulmonary nodules, leading to the unexpected diagnosis of metastatic BCC and timely initiation of targeted therapy. This abstract is funded by: None
Purzycki et al. (Fri,) studied this question.