10.5826/dpc.1301a2
text/xml
2160-9381
2170
en
Dimitrios  Dionysopoulos
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
metastatic
A case of metastatic basal cell carcinoma treated with carboplatin and paclitaxel
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2021-11-14
2023-01-31
2023-02-27
e2023002
Dermatol Pract Concept
Dimitrios  Dionysopoulos
2023/01/31
10.5826/dpc.1301a2
e2023002
Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
2160-9381
metastatic
en
e2023002
Jefford M, Kiffer JD, Somers G, Daniel FJ, Davis ID. Metastatic basal cell carcinoma: rapid symptomatic response to cisplatin and paclitaxel. ANZ J Surg. 2004;74(8):704-705. DOI: 10.1111/j.1445-1433.2004.03130.x. PMID: 15315581.
A case of metastatic basal cell carcinoma treated with carboplatin and paclitaxel
https://dpcj.org/index.php/dpc/article/download/2170/1908
   A Case of Metastatic Basosquamous Basal Cell
 Carcinoma Treated With Carboplatin and Paclitaxel
          Chryssoula Papageorgiou1, Zoe Apalla1, Eleni Timotheadou2, Konstantia Loga2,
                        Elizabeth Lazaridou1, Dimitrios Dionysopoulos2


1 Second Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
2 Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Papageorgiou Hospital, Aristotle University of
  Thessaloniki, Thessaloniki,Greece



Key words: basal cell carcinoma, vismodegib, chemotherapy, carboplatin, metastatic
Citation: Papageorgiou C, Apalla Z, Timotheadou E, Loga K, Lazaridou E, Dionysopoulos D. A Case Of Metastatic Basosquamous Basal
Cell Carcinoma Treated With Carboplatin And Paclitaxel.Dermatol Pract Concept. 2023;13(1):e2023002. DOI: https://doi.org/10.5826
/dpc.1301a2
Accepted: April 28, 2022; Published: January 2023
Copyright: ©2023Papageorgiouet al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Chryssoula Papageorgiou, MD, Second Dermatology Department, Aristotle University, 76 Agiou Pavlou, Pavlos
Melas, 564 29, Thessaloniki, Greece. Tel. +302313323873, Fax: +302310991473 E-mail: xrysapapageorgiou@gmail.com




Introduction                                                             BCC (BSC). Due to the presence of headaches, lacrimation
                                                                         and tinnitus, a head MRI and later a PET-CT scan were per-
Basal cell carcinoma (BCC) is the most common type of skin               formed. The latter revealed bones involvement (Figure 1A).
cancer. However, it rarely metastasizes. Herein, we present a            Following these findings, vismodegib treatment was initiated.
case of metastatic BCC treated with chemotherapy following               A new PET-CT was performed 3 months later that indicated
vismodegib treatment failure.                                            disease progression (Figure 1B, Figure 2A). Therefore, switch
                                                                         to carboplatin and paclitaxel-based chemotherapy was de-
                                                                         cided. One month after treatment initiation, the patient did
Case Presentation
                                                                         not longer suffer from the symptoms mentioned above. Ac-
An 82-year-old man visited our clinic for regular follow up              cordingly, three months later, a new PET-CT was performed,
due to a personal history of cutaneous BCC which was located             which revealed complete response of the BCC (Figure 2B).
on the face. The primary tumor was excised with clear mar-
gins 16 months ago and the histopathology report indicated a
                                                                         Conclusions
nodular BCC. Physical examination revealed a swollen lymph
node in the right anterior neck. The Fine Needle Aspiration of           Although BCCs are very common neoplasms, it is by nature
the lymph node demonstrated the presence of basosquamous                 extremely rare to metastasize.




Research Letter | Dermatol Pract Concept. 2023;13(1):e2023002                                                                             1
Figure 1. Metastatic BCC. (A) PET-CT at baseline displaying bone involvement and a mass of soft tissue in the skull base invading the clivus,
both petrosal bones and the right sphenoid bone. An additional mass of soft tissue is seen to protrude back of the right sphenoid bone to the
right sinus. (B) 3 months after vismodegib administration indicating progression of the disease (black arrow).




Figure 2. Comparative PET-CTs (A) before and (B) after 3 months treatment with carboplatin combined with paclitaxel (150 mg and 120 mg
were administered per week, respectively) revealing complete response and disappearance of the tumor brain metastases.


    In our patient, the primary tumor was histologically di-            it could serve as a very helpful tool for clinicians even in such
agnosed as a nodular BCC, whilst histology of the lymph                 cases to overcome this discrepancy [1,2].
node mass indicated a BSC, which is considered a more ag-                   Surgical excision with clear margins is the gold standard
gressive form of BCC. This discrepancy may be attributed to             of treatment of all BCCs. In contrast, in locally advanced and
sectioning limitations, not always allowing examination of              metastatic BCCs the therapeutic management seems to be
all the areas of the tumor, in conjunction with the possible            limited to the so-called sonic hedgehog pathway inhibitors
coexistence of different areas of differentiation within the tu-        (HHI), namely vismodegib and sonidegib. However, their use
mor mass. Mixed histology is a common scenario, especially              remains controversial in the case of BSCs. Specifically, several
in large BCCs. Recent introduction of line-field confocal op-           studies in the past demonstrated squamatization of BCC in the
tical coherence tomography for the in-vivo diagnosis of kera-           setting of acquired drug resistance during HHI therapy [3,4].
tinocyte tumors has improved BCC subtype recognition and                On the other hand, recent studies have reported complete
its aggressive variants like basosquamous carcinoma. Thus,              responses of locally advanced BSCs with vismodegib [5]. In



2                                                                            Research Letter | Dermatol Pract Concept. 2023;13(1):e2023002
our patient, vismodegib treatment was not beneficial. How-              2. Cappilli S, Cinotti E, Lenoir C, et al. Line-field confocal opti-
ever, 3-month treatment with carboplatin and paclitaxel led                  cal coherence tomography of basosquamous carcinoma: a case
                                                                             series with histopathological correlation. J Eur Acad Dermatol
to radiologically confirmed, complete response of the tumor.
                                                                             Venereol. 2022;36(8):1214-1218.. DOI: 10.1111/jdv.18038.
This is in line with previous evidence suggesting that cispla-
                                                                             PMID: 35224784.
tin-based chemotherapy may be associated with rapid symp-               3.   Iarrobino A, Messina JL, Kudchadkar R, Sondak VK. Emergence
tomatic responses [6]. However, despite the brilliant response               of a squamous cell carcinoma phenotype following treatment of
to the systemic therapy, long term follow- up will be of crucial             metastatic basal cell carcinoma with vismodegib. J Am Acad Der-
importance to evaluate the real efficacy of the therapy.                     matol. 2013;69(1):e33-e34. DOI: 10.1016/j.jaad.2013.01.023.
                                                                             PMID: 23768306.
   This case report illustrates the clinical challenge of
                                                                        4.   Bancalari B, Llombart B, Serra-Guillén C, et al. Histologic
managing patients with metastatic BCC with squamous
                                                                             Changes During Treatment With Vismodegib in Locally Ad-
differentiation and, subsequently, highlights the need of a                  vanced Basal Cell Carcinoma: A Series of 19 Cases. Am J
multidisciplinary approach among the clinicians involved                     Dermatopathol. 2019;41(10):711-717. DOI: 10.1097/DAD
for the patient benefit.                                                     .0000000000001384. PMID: 31436575.
                                                                        5.   Apalla Z, Giakouvis V, Gavros Z, et al. Complete response of
                                                                             locally advanced basosquamous carcinoma to vismodegib in two
References                                                                   patients. Eur J Dermatol. 2019;29(1):102-104. DOI: 10.1684
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 1. Cappilli S, Dejonckheere G, Hajjar N, et al. Line-field confo-      6.   Jefford M, Kiffer JD, Somers G, Daniel FJ, Davis ID. Meta-
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Research Letter | Dermatol Pract Concept. 2023;13(1):e2023002                                                                             3
