Intravascular Basal Cell Carcinoma Hiding under a Keratoacanthoma

A 79-year-old male presented for removal of what was proven to be a keratoacanthoma. Additional tissue removed deep to the initial lesion revealed intravascular basal cell carcinoma (BCC). Intravascular BCC is exceedingly rare with only 8 cases previously reported in the literature. Intravascular BCC may be associated with more aggressive subtypes. Intravascular infiltration is more common in metastatic BCC, but this finding may not imply causality. More data are required in order to determine prognostic implications of intravascular BCC and to develop a protocol for managing patients with this unique finding.