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Metastasizing basal cell carcinoma: A clinicopathologic and immunohistochemical study of 22 cases
Author(s) -
Mochel Mark C.,
Liaquat Samia,
Moore Johanna B.,
Hoang Mai P.
Publication year - 2021
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.13888
Subject(s) - immunohistochemistry , pathology , metastasis , medicine , cd44 , basal cell carcinoma , primary tumor , carcinoma , lung , cancer , cell , basal cell , biology , genetics
Basal cell carcinomas metastasize rarely, and there have been limited studies of potential drivers for this metastasis. Epithelial‐mesenchymal transition (EMT) may play a role, although this has not been investigated in detail. We reviewed clinicopathologic features of 22 patients with metastasizing basal cell carcinoma (MBCC). Immunohistochemical markers of EMT, including CD44, E‐cadherin, claudin, smooth muscle actin, beta‐catenin, Twist1, and Oct 3/4, were evaluated on 10 MBCC (primary and metastases) and 18 non‐metastasizing BCC. Primary sites included the head and neck, trunk, and extremity, while metastatic sites included lymph nodes, lung, bone, and soft tissue. Of 19 cases with follow‐up, the range of follow‐up after diagnosis of metastasis was 5 to 248 months (median: 50 months). Two cases were of unknown primary, nine metastases were diagnosed concurrently with primary tumors, and remaining cases showed a median latency between diagnosis of primary and metastatic tumors of 27.5 months (range: 3‐81 months). Median survival was 66 months. Compared to non‐metastasizing BCC, MBCC demonstrated reduced CD44 expression (primary [ P = .0036], metastatic [ P = .011]) and increased Twist1 expression (primary, P = .0017). MBCC shows variably aggressive behavior, and reduced CD44 and increased Twist1 expression may indicate significant EMT in metastasizing tumors and signify a metastatic phenotype.