Background:

The basal cell carcinoma is the most frequent malignant skin cancer. This tumor presents a low mortality but high morbidity due to its capability of tissue invasion. The sun UV exposure is the most important risk factor, being the white race the most affected. In the medical literature there is a reported incidence of lymph metastases less than 1% of the cases.

Case report:

We present a 72-years-old male which came to us with a right lower eyelid lesion. He was initially treated by reconstructive surgery with resection and skin graft and presented recurrence with extraocular muscles affection, which lead to enucleation. Nevertheless, he presented new evidence of local recurrence, and right jugular lymph metastases.

Discussion:

The basal cell carcinoma represents the most frequent malignant skin cancer, affecting mainly white race; despite its known high grade of invasion, there is only 1% reported metastases in the medical literature. Such clinical presentation represents a therapeutic challenge for the surgical oncologist due to its high index of recurrence and local tissue destruction.

Conclusion:

Metastatic basal cell carcinoma is an uncommon pathology for the surgical oncologist. This case illustrates the diagnostic and therapeutic challenge that represents. Due to its low metastatic incidence, this type of reports is essential to understand the actual experience and therapeutic options.

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