case_images: PMC5941720_01
case_images: Axillary ulcerating lymph node metastases of cutaneous basal cell carcinoma located on the left forearm.
case_images: CRIONM2018-3485326.001.jpg
case_images: PMC5941720_01_CRIONM2018-3485326.001.jpg
case_images: fig1
case_images: 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.
case_images: 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.
case_images: CRIONM2018-3485326.002.jpg
case_images: PMC5941720_01_CRIONM2018-3485326.002.jpg
case_images: fig2
case_images: 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).
case_images: (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).
case_images: CRIONM2018-3485326.003.jpg
case_images: PMC5941720_01_CRIONM2018-3485326.003.jpg
case_images: fig3
case_images: 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).