Vol.:(0123456789) 1 3 Archives of Dermatological Research https://doi.org/10.1007/s00403-020-02120-y ORIGINAL PAPER Metastatic head and neck cutaneous basal cell carcinomas: a retrospective observational study Karina Furlan 1  · Vijaya Reddy 1  · Anas Alabkaa 1  · Prih Rohra 1  · Fatima Mir 1  · Paolo Gattuso 1 Received: 4 May 2020 / Revised: 7 July 2020 / Accepted: 31 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Cutaneous basal cell carcinoma is usually an indolent and slow-growing tumor with potential for local invasion and recur- rence; however, metastatic events are exceedingly rare. The annual incidence of metastasis is estimated to range between 0.00281 and 0.05%. A retrospective search in the pathology database of a single tertiary institution was performed in the period between 1999 to 2019. Primary cutaneous metastatic basal cell carcinomas had parafn blocks and glass slides retrieved. A total of 8673 cases was identifed. The overall prevalence of metastatic tumors was 0.05% (4/8673). The median patient’s age at diagnosis was 61 years old (range 52–79). The most common primary site of tumor was nose (2/4) and the most common histological subtype was infltrative. The sampled lymph nodes were identifed during primary tumor resec- tion, except for 1 patient who had a sentinel lymph node biopsy performed as a surgeon individual decision. One patient had hematogenous spread to the pleura, diagnosed 5 years after diagnosis. In summary, this study adds new data to the cur- rent literature in metastatic primary cutaneous basal cell carcinomas and highlights the importance of early diagnosis and appropriate surgical excision in an efort to prevent local advanced disease, recurrence and lymphovascular dissemination. Keywords Metastatic basal cell carcinoma · Head and neck basal cell carcinoma · Pleural metastasis BCC · Lymph node metastasis BCC Introduction Basal cell carcinoma (BCC) of the skin is the most common human cancer in Caucasians [1]. It is usually an indolent and slow-growing tumor with the potential for local inva- sion and recurrence [2, 3]; however, metastatic events are exceedingly rare [2, 4]. The annual incidence of metastasis is estimated to range between 0.00281 and 0.05% [5, 6]. Less than 400 cases of metastatic BCCs have been described to date [1], and the majority of them have originated from the head and neck regions [1, 6–12]. The risk of metastasis is higher in patients with neglected, large, and recurrent tumors that invade the surrounding structures (Table 1: summary of risk factors for metastatic BCC). Most of the literature on metastatic BCC comprises single case reports [1, 4, 8, 9, 13–15]. In this retrospective study, we aim to estimate the preva- lence, over the last 20 years, of metastatic primary cuta- neous BCCs as primary outcome. As secondary outcome, we intend to describe clinical and histological aspects of metastatic tumors. Methods A retrospective search for head and neck cutaneous BCCs was conducted in the pathology database of a single tertiary institution in the period ranging from 1999 to 2019. Meta- static BCCs had parafn blocks and glass slides retrieved. Tumors showing squamoid or adnexal diferentiation were excluded. Patient`s demographic data and operatory notes were obtained from electronical medical records. The fol- lowing information was retrieved: tumor`s size and loca- tion, histological subtype, number and location of sampled lymph nodes, number of positive lymph nodes and pres- ence/absence of extra-capsular extension, ulceration, peri- neural invasion, depth of invasion and adjuvant treatment, if performed. * Karina Furlan karina_furlan@rush.edu 1 Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, IL 60612, USA