Metastatic basal cell carcinoma from head and neck primary lesions

Basal cell carcinoma is the most common cutaneous neoplasm and involves the head and neck in more than 85% of cases. Metastatic lesions occur in less than 0.1% of cases. In this report, four cases of metastatic basal cell carcinoma of the head and neck are presented. Previous reports indicate that metastases typically arise from longstanding, large and deep locally invasive lesions that are refractory to surgical or radiation therapy. Although three of the four cases follow this pattern, one case demonstrates that a small but rapidly enlarging lesion also has the potential for metastasis. The relationship of metastasis to tumor growth, histologic subtype, and host immune function is discussed.