Basal cell carcinoma with metastasis. Review of literature.

Basal cell carcinoma (BCC) is the most common form of skin cancer, accounting for 65% to 75% of all malignant skin tumors. Metastic BCC is very rare--only 109 documented cases have been reported to date. The mean time of survival after metastasis has been reported to be ten months. No effective therapeutic modality is known for its treatment. We are reporting a case of metastatic BCC in which we have found deficiency of cell-mediated immunity. Postmortem studies showed a co-existing squamous cell carcinoma in thelungs, brain, liver, and spleen. The most unusual finding in the postmortem study was evidence of juxtaposition of BCC and epidermoid carcinoma with distinct histologic dimorphism. We speculate that a combination of immunodeficiency and stromal independence is needed for metastases in BCC.