Basal cell carcinomas usually grow by direct extension. Rarely they can metastasize. Lattes and Kessler listed criteria for making the diagnosis of a metastasizing basal cell carcinoma.
Criteria for the diagnosis of metastasizing basal cell carcinoma:
(1) The primary tumor arose in the epidermis or follicular skin.
(2) There is spread to a distant site NOT by direct extension.
(3) Both the primary tumor and metastastic tumor show the same histologic appearance AND show a component of basal cell carcinoma.
It is important to exclude a basaloid tumor arising from a site other than skin.
Features of metastasizing basal cell carcinoma:
(1) Most arise in the head and neck.
(2) Most are mixed with a squamous component.
(3) Distant metastases may be to lymph nodes, lung, bone, skin, liver and brain.
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