title: Orbitofacial Metastatic Basal Cell Carcinoma: Report of 10 Cases.
abstract: OBJECTIVE
  To explore the clinical features, management, and prognosis of metastatic basal cell carcinoma originating in the orbitofacial region.
  
  
  METHODS
  Ten cases of orbitofacial metastatic basal cell carcinoma were identified by searching databases at 2 institutions from 1995 to 2015. A retrospective chart review was performed. Main outcome measures included patient demographics, lesion size, location of metastases, histologic subtype, recurrence rate, time between primary tumor diagnosis and metastasis, perineural invasion, treatment modalities, and survival from time of metastasis.
  
  
  RESULTS
  The median tumor size at largest dimension was 3.3 cm (range, 1.9-11.5 cm), and 6 of 10 patients had at least 1 local recurrence before metastasis (range, 0-2 recurrences). The most common sites of metastasis included the ipsilateral parotid gland (n = 6) and cervical lymph nodes (n = 5). Histologic subtypes included infiltrative (n = 5), basosquamous (n = 2), nodular (n = 1), and mixed (n = 1). The median time from primary tumor diagnosis to metastasis was 7.5 years (range, 0-13). The median survival time from diagnosis of metastasis to last documented encounter or death was 5.3 years (range, 7 months-22.8 years). Treatment regimens included surgical excision, radiotherapy, and hedgehog inhibitors.
  
  
  CONCLUSIONS
  Based on our findings, the following features may be markers of high risk orbitofacial basal cell carcinoma: 1) increasing tumor size, 2) local recurrence of the primary tumor, 3) aggressive histologic subtype, and 4) perineural invasion. Screening should include close observation of the primary site and tissues in the distribution of regional lymphatics, particularly the parotid gland and cervical lymph nodes.
authors.affiliation: *Department of Ophthalmology, Wake Forest University Eye Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, and †Ophthalmic Plastic and Orbital Oncology, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.
authors.forename: Sara V
authors.initials: SV
authors.lastname: Branson
authors.forename: Elysa
authors.initials: E
authors.lastname: McClintic
authors.forename: Omar
authors.initials: O
authors.lastname: Ozgur
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
authors.forename: R Patrick
authors.initials: RP
authors.lastname: Yeatts
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary*; D005153:Facial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009918:Orbital Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology