Total excision of primary tumors following recommended treatment guidelines does not tend to halt metastatic spread,4 and prior to discovery of metastases, lesions generally tend to recur locally following excision and/or radiation therapy.1,4,9 Approximately equal rates of hematogenous and lymphatic spread are observed, and the lung is the most likely distant organ to be involved, followed by bone, liver, and pleura.3 Cases of bone metastasis may present with symptoms of spinal cord compression6 or anemia,15 as well as bone pain17 and pathologic fractures,7,15 and tend to involve the lumbar spine more frequently than the thoracic and cervical regions.10 Our patient did not complain of any such symptoms indicative of osseous lesions, even with extensive bony involvement.
von Domarus and Stevens3 noted a slightly better survival rate among patients with lymphatic metastases versus those patients whose tumors disseminated hematogenously. Patients with metastatic BCC have a 5-year survival rate of approximately 10%; patients with distant spread typically survive only 10 to 14 months.1 Prognosis is especially poor with metastases to the lungs, bone, or liver,12,16 and palliative treatment generally is used in these cases.
Aggressive treatment should be pursued if BCC metastasis has been detected. Unfortunately, once distant metastasis occurs, cure is not possible and survival generally is short.12 Excision of the primary lesion with free margins is the initial objective, but it may not always be possible due to the size or extent of the tumor. Therapeutic options for bone metastases include chemotherapy with agents such as cyclophosphamide, etoposide, fluorouracil, methotrexate, cisplatin, bleomycin, and doxorubicin.11 Radiation therapy is an effective palliative treatment, but its use has not demonstrated increased survival benefit.12 Laminectomy has been used for vertebral involvement.10,12 Because of the rare nature of metastatic BCC, appropriate treatment protocols have not been formulated, and combination therapy with the above modalities generally is employed. Nevertheless, therapeutic response to treatment usually is poor. Because of our patient's untimely death, no treatment options were sought.