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Soo Park, MD
Soo Park, MD
Posted: Tuesday, May 31, 2022
A rare case of metatypical basal cell carcinoma has demonstrated the difficulties in diagnosis and treatment of this understudied and aggressive variant of basal cell carcinoma. This case study was published in the Annals of Agricultural and Environmental Medicine. “It should always be taken into account that each case of diagnosed [basal cell carcinoma] may turn out to be its metatypical variant, with a much more aggressive course and worse prognosis,” said Barbara Madej Czerwonka, MD, PhD, and Agnieszka Korga-Plewko, MD, PhD, DSc, of the Medical University, Lublin, Poland. “For this reason, after completed treatment, intensive follow-up is recommended.”
In 2002, a 37-year-old male patient received a diagnosis of ulcerative basal cell carcinoma at a surgical oncology clinic. Following surgery, regular checkups were scheduled at an outpatient clinic. In 2012, the patient reported chronic fatigue and headaches radiating toward the neck. Blood tests found no abnormalities. However, further tests revealed enlarged parietal lobes, a tumor located in the right mandibular angle with infiltration of the right jugular vein, lesions on the lungs, and multiple enlarged lymph nodes. Tissue samples were collected, leading to a suspected diagnosis of metatypical basal cell carcinoma.
The doctors prescribed resection and 10 cycles of AP-3 (the cytotoxic molecule ansamitocin P-3) chemotherapy. Following treatment, a PET/CT scan revealed a tumor in the thyroid cartilage. Further tumor resection plus radiotherapy was attempted. However, 6 months after surgery, two additional metastatic tumors were identified. The patient next underwent further tumor resection, immunotherapy with vismodegib, and chemotherapy, which were unsuccessful in preventing disease progression. The patient was hospitalized for fatigue, dehydration, and severe abdominal and cervical pain, also experiencing cachexia and a large neck ulceration. The patient died 15 years after the original diagnosis.
Disclosure: The study authors reported no conflicts of interest.
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