Unusual Presentation of Phlebolymphedema After Metastatic Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most frequent skin cancer, usually occurs in the head and neck, but very uncommon extra-facial locations. Metastatic disease is an extremely rare finding. The aim of this report is to share an atypical clinical case of phlebolymphedema.

Methods: A 61-year-old male patient with a solitary non-healing ulcer on the left leg secondary to history of trauma. Progressively worsened over 3 months which was surgically managed. Biopsy revealed an ulcerative basal cell carcinoma. At follow-up 24 months later he had woody, indurated, non pitting edema on his left leg extending to his proximal thighs. Contrast-enhanced computed tomography of the abdomen and pelvis, Doppler ultrasound imaging of the lower limb veins and lymphoscintigraphy helped to confirm the diagnosis of left Iliac vein compression (ILVC) due a fibrotic tissue. A biopsy confirmed metastatic basal cell carcinoma (MBCC).

Results:

ILVC was treated with balloon angioplasty and stenting. Compression therapy following bandaging was well tolerated with significant improvement for 2 weeks. CT chest scans done 7 months later post-incomplete treatment with Vismodegib  and without controls revealed pulmonary lesions, which were biopsy-proven MBCC.

Conclusions:

This is a rare case of BCC metastases which has limited treatment options. We extensively discussed the differential diagnosis and different therapeutics options. This case provides insight of the patient experience on such treatment.