# Insights into basal cell carcinoma with bone metastasis: a comprehensive review

## TL;DR

This paper reviews 108 cases of rare basal cell carcinoma with bone metastases, highlighting the need for personalized treatment due to aggressive subtypes.

## Contribution

The study compiles and analyzes a large case series of BCC with bone metastases, emphasizing the importance of histological subtypes in clinical management.

## Key findings

- Infiltrative, morphoeaform, and other aggressive BCC subtypes are associated with bone metastases.
- Bone pain and hypercalcaemia are key symptoms for early detection in high-risk patients.
- Personalized treatment combining surgery, chemotherapy, and immunotherapy is essential for managing aggressive BCC subtypes.

## Abstract

Basal cell carcinoma (BCC), the most common skin cancer worldwide, is closely associated with sunlight exposure and generally exhibits a low metastatic potential, with a frequency ranging from 0.0028% to 0.55%. Despite its rarity, BCC with bony metastases causes important clinical complications. We collected information on published patients with a diagnosis of BCC with bony metastases, and examined patient demographics, tumour characteristics, histological features and treatment modalities to define patterns and outcomes. Our study encompassed 108 patients: 68 men and 40 women with a mean (SD) age of 66.9 (6.4) years. Histologically identified subtypes included 42 nodular, 28 infiltrative, 9 morphoeaform, 5 metatypical and 1 superficial BCC, with 23 patients having a mixed histopathology pattern. The main treatments were ­surgery (n = 98), chemotherapy (n = 31), immunotherapy (n = 16) and radiotherapy (n = 34). BCC with bone metastases, although rare, requires more attention due to the complexity of management. Histological subtypes such as infiltrative, sclerosing, morphoeaform, basosquamous and micronodular are associated with aggressive behaviour and the detection of symptoms such as bone pain or hypercalcaemia in patients at high risk of metastasis is important for timely diagnosis. Because of the aggressive potential and clinical implications of some subtypes, a personalized management approach with comprehensive histological and molecular profiling is essential to optimize outcomes in patients with BCC with bone metastasis.

Basal cell carcinoma (BCC), the most common skin cancer, typically shows low metastatic potential but causes significant clinical complications when metastatic to bone. This review examines 108 cases of BCC with metastatic bone cancer, examining patient populations, tumour characteristics, histologic subtypes and treatment. Despite the rarity of BCC with bone metastases, some histological subtypes require an individualized approach due to their aggressive nature and challenging treatment.