Vulvar basal cell carcinoma: An infrequently metastasizing neoplasm

A case of metastasizing basal cell carcinoma (BCC) of the vulva is presented and compared with 10 nonmetastasizing tumors of the same histologic type by various clinicopathologic parameters. The former neoplasm manifested several features that distinguished it from most of the nonmetastasizing tumors, such as vaginal bleeding at presentation; advanced clinical stage; invasion of subcutaneous fat, urethra, and vagina; tumor thickness greater than 1 cm; and a morphealike pattern of growth. This series, in conjunction with previously published observations, would suggest that vulvar BCC behaves much like its counterpart in sites other than the vulva, locally recurring but metastasizing only on rare occasion. Simple wide excision of the tumor is curative in the majority of cases. More aggressive surgery may be warranted for large tumors that are locally destructive and extend into the subcutaneous fat, like our metastasizing case and the two other examples of metastasizing vulvar BCC in the literature. In this report, treatment options for vulvar BCC are discussed, as well as the use of the term basosquamous carcinoma, and whether vulvar BCC may be a manifestation of a more generalized syndrome of cutaneous basal cell neoplasia in some cases.