A case of vulval basosquamous basal cell carcinoma with possible pelvic lymph node metastases

Background: Basal cell carcinoma (BCC) is the most common cutaneous neoplasm. It is most often a locally invasive tumour and rarely affects the vulva. Distant spread of BCC is rarer still and there are few cases reported of metastatic vulval primary tumours. Basosquamous carcinoma is regarded as a high-risk variant of BCC and its behaviour is unpredictable. Though more aggressive, it tends to grow locally rather than spread to lymph nodes as seen in squamous cell carcinoma (SCC). Case: We present a case of a basosquamous BCC arising in the vulva with involvement of the external and common iliac lymph nodes. Conclusion: Metastatic BCC has a poor prognosis and there are no definitive guidelines for its investigation or management. We recommend staging with imaging and potentially lymph node dissection in patients with large lesions involving underlying structures or aggressive histology.