Ramez Awad1, Juan Camilo Barreto Andrade2, Heba Mousa3, Fade Mahmoud4. 1. Assistant Professor at the University of Arkansas for Medical Sciences in Little Rock. rawad@uams.edu. 2. Assistant Professor in the Department of Surgical Oncology at the University of Arkansas for Medical Sciences in Little Rock. jcbarretoandrade@uams.edu. 3. Clinical Instructor in the Department of Allergy and Immunology at Ain Shams University in Cairo, Egypt. hebamousa224@gmail.com. 4. Medical Oncologist at the TW Lewis Melanoma Center of Excellence at Banner MD Anderson Cancer Center in Gilbert, AZ. fade.mahmoud@bannerhealth.org.
Abstract
INTRODUCTION: Basal cell carcinoma (BCC) is the most common skin cancer. It is primarily a local disease, and it very rarely causes metastatic disease. Chemotherapeutic agents had limited success in management of metastatic disease until the introduction of vismodegib. In this case report, we describe the presentation of a metastatic BCC that was not amenable to surgical resection or local treatment options and was treated successfully with vismodegib. CASE PRESENTATION: A 69-year-old white man was referred to our surgical clinic for evaluation of an erosive left shoulder lesion. Biopsy in the clinic showed BCC with evidence of metastases on positron emission tomography-computed tomography scan. Tumors had invaded multiple bony structures and multiple organs, making surgical resection not an option. The decision was made to treat the patient with vismodegib. At 1-year follow-up, the patient's left shoulder lesion had improved with no evidence of metabolically active distant metastasis. DISCUSSION: Although BCC is the most common skin cancer, it is usually a local disease and treated with local measures. Metastatic BCC is extremely rare, and in cases when surgical resection or local radiation are not viable options, chemotherapeutic agents typically offer very limited improvement. Vismodegib is an oral selective sonic hedgehog pathway inhibitor that shows benefit in patients with locally advanced or metastatic disease.
INTRODUCTION:Basal cell carcinoma (BCC) is the most common skin cancer. It is primarily a local disease, and it very rarely causes metastatic disease. Chemotherapeutic agents had limited success in management of metastatic disease until the introduction of vismodegib. In this case report, we describe the presentation of a metastatic BCC that was not amenable to surgical resection or local treatment options and was treated successfully with vismodegib. CASE PRESENTATION: A 69-year-old white man was referred to our surgical clinic for evaluation of an erosive left shoulder lesion. Biopsy in the clinic showed BCC with evidence of metastases on positron emission tomography-computed tomography scan. Tumors had invaded multiple bony structures and multiple organs, making surgical resection not an option. The decision was made to treat the patient with vismodegib. At 1-year follow-up, the patient's left shoulder lesion had improved with no evidence of metabolically active distant metastasis. DISCUSSION: Although BCC is the most common skin cancer, it is usually a local disease and treated with local measures. Metastatic BCC is extremely rare, and in cases when surgical resection or local radiation are not viable options, chemotherapeutic agents typically offer very limited improvement. Vismodegib is an oral selective sonic hedgehog pathway inhibitor that shows benefit in patients with locally advanced or metastatic disease.
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