Pulmonary Metastases From a Long-Standing Untreated Facial Basal Cell Carcinoma: A Rare Case Report.

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and is typically characterized by slow growth, local tissue invasion, and an excellent prognosis when treated early. Although metastatic disease is exceedingly uncommon, the lungs are among the most frequently reported sites of distant spread. We report the case of a 64-year-old man with a 15-year history of untreated facial BCC who presented with a painful ulcerated lesion associated with chronic purulent drainage, progressive visual decline in the left eye, difficulty with mastication, and unintentional weight loss of approximately 50 lbs over two years. Physical examination revealed a destructive 13 × 15 cm ulcerative neoplastic lesion involving the left hemiface, temporal region, occipital region, auricular area, and ipsilateral neck, with extensive tissue destruction, exposed bone, necrosis, foul-smelling purulent drainage, and findings concerning for superimposed soft tissue infection. Imaging demonstrated extensive craniofacial destruction involving the temporal bone, zygomatic arch, and mandibular condyle, while chest computed tomography revealed multiple bilateral spiculated pulmonary nodules measuring up to 2.5 cm. Histopathologic examination of the facial lesion confirmed BCC, and CT-guided biopsy of a pulmonary nodule established the diagnosis of metastatic BCC. The patient received broad-spectrum intravenous antibiotics for the superimposed infection and was evaluated for systemic therapy with vismodegib or cemiplimab. This case illustrates how prolonged treatment delay can transform a highly curable malignancy into locally destructive and metastatic disease.