Basal cell carcinoma with pulmonary and lymphatic metastases and TERT-promoter mutation

Basal cell carcinoma (BCC) is a common epithelial skin cancer. Other than cutaneous squamous cell carcinoma, apart from its aggressive loco-regional destructive growth, it has a very good prognosis. However, metastasis is reported in the literature. Nevertheless, its existence is still discussed controversially and the diagnosis is difficult. We describe the case of a 60-year-old man who had been diagnosed with lymph node and lung metastases of a basaloid carcinoma. Re-microscopy of earlier excised skin tumors revealed a locally recurrent BCC with a histomorphological similar appearance. Additionally performed molecular genetic analysis revealed identical telomerase reverse transcriptase-promoter mutation in the cutaneous BCC and in the lymph node metastasis with a typical UV-signature.