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Management of basal cell carcinoma with pulmonary metastasis
  1. Samuel Achilles Fordham1,
  2. Emily Ximin Shao2,
  3. Leith Banney1,
  4. Mary Azer3 and
  5. Andrew Dettrick4,5
  1. 1Dermatology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
  2. 2Dermatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  3. 3Oncology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
  4. 4Sunshine Coast University Hospital, University of Sunshine Coast, Birtinya, Queensland, Australia
  5. 5Pathology, Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
  1. Correspondence to Dr Samuel Achilles Fordham; sfordham2020{at}


A man in his 50s presented with an ulcerative lesion within the left axillary fold that had progressively worsened over 18 months. Biopsy revealed an ulcerative basal cell carcinoma (BCC), which was surgically managed. CT chest scans done 7 months later assessed post-treatment of radiotherapy. This revealed pulmonary lesions, which were biopsy-proven metastatic BCC. Sonidegib, a hedgehog signalling inhibitor, was used for first-line treatment. Due to progressive disease, sonidegib was ceased. Cemiplimab, a checkpoint inhibitor, was used as second-line treatment based on a phase II trial demonstrating efficacy in the setting of metastatic BCC. CT reports were initially consistent with response but after 6 months of cemiplimab treatment, repeat CT chest scans revealed a decrease in size of the previously cited pulmonary lesions.

This is a rare case of BCC metastases which has limited treatment options. This case provides insight of the patient experience on such treatment.

  • Dermatology
  • Malignant disease and immunosuppression
  • Skin
  • Skin cancer
  • Plastic and reconstructive surgery

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  • Contributors All authors who are cited within the case report have contributed to the management and progress of the patient’s journey. SAF was responsible for the write up of the manuscript and collating all medical records and documentation. Submission of the manuscript was also done by SAF. All revised changes during the drafting process were completed by SAF. EXS was responsible for obtaining patient consent for the case report and documentation while making appropriate editorial changes within the manuscript. EXS also reviewed the manuscript. LB made appropriate suggestions to the editorial changes during the drafting process of the manuscript. LB also reviewed the manuscript. MA provided necessary medical documentation for the case report while making editorial changes throughout the drafting process. MA also reviewed the manuscript. The addition of Associate Professor Andrew Dettrick in the case report is attributed to the work he has contributed to the manuscript. This includes sourcing the histological specimens with text commentary, revision of the manuscript with additional comments on basal cell carcinoma pathology, construction of the data in a way that is accessible to readers and recommendations regarding the interpretation of histological specimens.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.