Experience with treating basal cell carcinoma of the occipital region with regional lymph node metastasis

Basal cell carcinoma (BCC) is the most common cancer of the skin, it accounts for 75-97% of all skin tumors. Nowadays, there is a wide range of local treatment options for BCC. The disease frequently occurs in the head and neck region. Because BCC tends to recur, it is necessary to find the most effective treatment option for the disease with account of cosmetic results. Although the BCC prevalence is rather high, metastatic disease occurs rarely (0,008-0,55%). Maybe it is the reason for lack of recurrent BCC patients management algorithm in the current clinical guidelines. The article presents the report of clinical observations on the development, treatment and outcomes of recurrent BCC in the occipital region with cervical lymph node metastasis. Neck lymph nodes were treated with two-phase conventionally fractionated radiotherapy to the total dose of 60 Gy. For treatment of recurrent BCC in the occipital region we performed a course of external beam radiation therapy to the total dose of 66 Gy followed by the 6 month targeted therapy with the SMO inhibitor vismodegib (a smoothened transmembrane protein). There was no evidence of disease recurrence 11 months after the therapy completion. Radiotherapy in combination with targeted therapy was shown to be highly effective and safe treatment of recurrent, locally advanced BCC in the head and neck with regional lymph node metastases. The used method seems to be a reasonable alternative approach to the treatment of BCC when other conservative therapy options have been exhausted and surgical therapy is not possible.