Metastasis of a Basal-cell Epithelioma Report

The title “Metastasis of a Basal-cell Epithelioma” might be considered a “ contradiction in terms,” as absence of metastasis is generally considered one of the cardinal characteristics of basal-cell epithelioma. Sutton (1) defines basal-cell epithelioma as “ a comparatively benign variety of carcinoma of the skin which probably develops from the basal layer of the epidermis or from the skin glands, does not metastasize, and is composed of small, deeply staining cells of various forms.” Delafield and Prudden (2) state that “lymph glands are seldom involved by basal-cell epithelioma, and if so, there is a change in the structure of the growth.” Hazen (3) advises that “all surgeons should become familiar with this class of tumors, for they do not metastasize and hence it is not necessary to remove the adjoining lymph glands. When glandular involvement is spoken of as occurring in this group of tumors, it is probable that there is an error in diagnosis and that the growth is really of cuboidal cellular origin.” This view is shared by H. Montgomery (4), who says that “careful examination will prove practically all such metastatic tumors to be either transitional or squamous-cell in character.” Several cases of metastasis of this transitional or basalsquamous-cell epithelioma have been reported, and a small number of cases of pure basal-cell epithelioma in the original growth, with the mixed type or pure squamous-cell epithelioma in the involved gland, are on record. A thorough search through the literature has revealed only five histologically proved cases of metastasis of a pure basal-cell epithelioma in which both the original growth and the metastasis were of pure basal-cell type. The first case of this kind was reported by Beadles ( 5 ) in 1894.