Metatypical basal cell carcinoma: A successful balance between oncologic outcome and aesthetic result, a case report

Metatypical basal cell carcinoma is a rare and aggressive subtype of skin cancer. It necessitates a careful and nuanced approach to management. The first-line treatment is a wide surgical excision, which can lead to significant tissue loss. Herein is our case. A 67-year-old female patient presented with an ulcerated exophytic mass on the right parietal scalp. She underwent a large excision of the tumor, sentinel lymph node biopsy, and reconstruction with a transposition flap. Histopathological examination revealed a metatypical basal cell carcinoma with minimal clear surgical margins of 1 cm; lymph nodes were negative. Adjuvant radiotherapy was recommended. Metatypical basal cell carcinoma is a rare and aggressive subtype of non-melanoma skin cancer, accounting for about 2 % of all cases. It has a higher risk of metastasis and recurrence compared to typical basal cell carcinoma. Metatypical basal cell carcinoma most often develops in sun-exposed areas of the head, although it can occur in other locations less frequently. Despite the absence of established treatment guidelines, it is recommended to use wider surgical margins than those typically applied for basal cell carcinoma. This approach often leads to substantial tissue loss, which may necessitate challenging reconstructive procedures. Ongoing research is crucial as we navigate the complexities of managing metatypical basal cell carcinoma, particularly concerning surgical margin cutoffs, lymph node staging, and adjuvant therapies. Due to its rarity, metatypical basal cell carcinoma presents ongoing challenges with no consensual management strategies. •Metatypical basal cell carcinoma is a rare form of skin cancer.•It should be considered and treated as an aggressive form of basal cell carcinoma.•Wide surgical margins are recommended which can result in significant tissue loss.•Skin reconstruction is challenging when significant tissue is lost.