PMC5941720_01
Axillary ulcerating lymph node metastases of cutaneous basal cell carcinoma located on the left forearm.
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On initial presentation, we observed an 8 x 15 cm measuring wound on the left forearm and a 5 x 8 cm measuring and 3-4 cm deep ulceration of the left axilla (Figure 1). Initially, the cutaneous and pulmonary metastases decreased in size (Figure 2, arrow 1), but 6 months after starting vismodegib, radiotherapy of refractory and slowly progressive ulcerations of the left axilla and the forearm had to be performed.
Computer tomography demonstrating pulmonary metastases two months before treatment (t = -2 M), with partial regression after 3 months of vismodegib treatment (t = 3 M, arrow 1) and with progressive disease after 11 and 14 months (arrow 1). Arrow 2 indicates new metastasis first visible on the CT scan after 11 months of treatment.
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A metastasized BCC was diagnosed, and subsequent radiographic diagnostics revealed a pleural effusion in the right lung and multiple suspicious lesions in both lungs (Figure 2). Initially, the cutaneous and pulmonary metastases decreased in size (Figure 2, arrow 1), but 6 months after starting vismodegib, radiotherapy of refractory and slowly progressive ulcerations of the left axilla and the forearm had to be performed. Pulmonary metastases demonstrated progression 9 months after starting vismodegib (Figure 2).
(a) H&E staining of pulmonary metastatic tissue demonstrating typical hyperchromatic basaloid cells (x200). (b) Positive BerEP4 staining of tumor tissue (x200). (c) Positive CK 5/6 staining of tumor tissue (x200).
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The carcinomatous pulmonary tissue matched to the lesion on the patient's left forearm by histology and immunohistochemistry with strong marking of CK 5/6 and a positive reaction to BerEP4 (Figure 3).