Unknown Lesions Found on a 51-Year-Old Man With Eyelid Cyst

Robert S. Bader, MD

Disclosures

February 03, 2020

Basal cell carcinoma is typically a slow-growing tumor that may ulcerate as it enlarges. Typically, tumors tend to bleed with the slightest trauma and are not painful. Some lesions heal spontaneously and can reulcerate or heal with scar.

Metastasis is extremely rare, occurring in less than 0.55% of cases. The tumor requires its supporting stroma for survival, making metastasis rare. Metastasis is twice as common in men as in women, and immunosuppression is not a risk factor. Most basal cell carcinomas that do metastasize are on the head and neck, are large, and are recurrent. Perineural or intravascular basal cell carcinoma are risk factors for metastasis. The regional lymph nodes are the most common site of metastasis, followed by lung, bone, skin, liver, and pleura. Tumors have been reported to metastasize 45 years after the primary diagnosis. Once metastasis occurs, less than 20% of patients survive 1 year.

A definitive diagnosis can usually be made easily with a skin biopsy, which should be performed in all cases to determine the histologic subtype of tumor. In nearly all cases, a shave biopsy is all that is required. In the case of pigmented basal cell carcinoma, which can have some clinical features of a malignant melanoma, a punch biopsy is recommended because if the lesion proves to be a melanoma, recording the depth of the tumor is essential.

In addition, if a basal cell carcinoma is clinically suspected, but not found with a shave biopsy, a punch biopsy may be helpful in establishing a diagnosis, especially when infiltrative and morpheaform types of basal cell carcinoma are suspected. Because these tumors rarely metastasize, additional laboratory and imaging studies are not commonly indicated unless involvement of deeper structures, such as bone, is clinically suspected, in which case CT or radiography can be used.

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