Objective:

This case report aims to educate other healthcare providers on the interdisciplinary management of advanced Basal Cell Carcinoma (BCC) of the scalp.

Background:

Basal cell carcinoma (BCC) is the most common type of non-melanoma skin cancer. It is associated with UV exposure and has genetic risk factors such as basal cell nevus syndrome (BCNS). BCC is locally aggressive but rarely metastasizes. Important consequences of undertreated BCC of the scalp include neurologic sequelae such as meningitis, seizures, and hypercoagulability.   

Design/Methods:

Not Applicable

Results:

A 73-year-old male with history of BCNS and recurrent BCC was admitted for scalp ulceration and drainage. His neurologic exam exhibited encephalopathy with no focal deficits. An MRI brain revealed vasogenic edema in the right frontoparietal lobe with right sided pachymeningeal enhancement. The patient was started on empiric antimicrobials. He underwent an extensive neurosurgical procedure with flap grafting. The biopsy confirmed invasive BCC into the skin, skull, and brain. The culture had polymicrobial speciation. Post-operatively the patient had persistent encephalopathy and new left sided hemiparesis. Repeat CT head imaging was negative. He was empirically treated for seizure, which could not be confirmed by EEG due to his cranial flap. On post-operative day 5 the patient developed new bradycardia. An echocardiogram demonstrated a right atrial thrombus. He was managed with heparin. Unfortunately, the patient remained encephalopathic with minimal meaningful recovery. He was later transitioned to comfort care and passed away.

Conclusions:

While BCC is a benign form of cancer, local invasion, especially of the scalp, can have devastating consequences. This case demonstrates neurological sequela of seizure, cerebritis, and encephalopathy due to direct spread into the brain. It also exemplifies worsening systemic complications of hypercoagulability from the dissemination of his cancer. Ultimately, this case highlights the importance of early detection and prompt treatment of BCC to prevent the rare but severe neurologic sequelae.