Background: Metastastic BCC (MBCC) is exceedingly rare with an incidence of 0.0028%. To date 350 accounts of MBCC are described. Over 85% of cases begin in the head and neck region. We report a case of MBCC in a healthy 29 year-old male. Case Presentation: This patient was first diagnosed with BCC 10 years prior to presenting to our service. He underwent excision of a nodule overlying the site of his previous lesion which confirmed recurrent BCC, fully excised. He represented 5 years later with a firm nodule in his left posterior triangle. FNA confirmed MBCC and he underwent left posterolateral selective neck dissection of levels III-V . Histopathology confirmed MBCC involving a single lymph node at level V with extranodal extension , perineural and lymphovascular invasion. At 8 months follow up there is no evidence of recurrence
Discussion: Despite therapeutic developments, prognosis for MBCC remains poor. Treatment is dictated by tumour location and extent of metastatic spread. Surgery remains the primary therapeutic option. MBCC with distant metastasis carries the worst prognosis. Most recently we have seen advances in systemic therapies for MBCC in the form of hedgeway pathway inhibitors.
Conclusion: Early recognition and aggressive management of MBCC is key to improving survival and patient outcomes. We the authors hope that this case report aids other physicians in the management of this uncommon presentation.