Basal cell carcinoma with bone invasion: A systematic review and pooled survival analysis

J Am Acad Dermatol. 2022 Mar;86(3):621-627. doi: 10.1016/j.jaad.2021.06.889. Epub 2021 Jul 14.


Background: Although basal cell carcinoma (BCC) tends to follow an indolent course, some tumors can exhibit locally aggressive behavior and invade into bone.

Objective: To analyze all published demographic, clinical, and treatment data on recurrence patterns, disease progression, disease-specific death, and overall mortality of BCC with bone invasion.

Methods: A systematic review and pooled-survival analysis was performed, including case reports and case series of BCC with bone invasion.

Results: The study included 101 patients from 70 publications. BCC tumors invading into bone were most often large, neglected tumors located in high-risk face areas. At 5 years, patients had a 30% risk probability of disease recurrence (after negative margins), a 72.1% risk of disease progression or death (with ambiguous margin status), an 18.2% risk of BCC-related death, and a 20.7% overall probability of death.

Limitations: Limitations include the reliance on case reports and series for individual patient data, which has the potential to introduce selection bias.

Conclusion: The high rate of disease progression and suboptimal 5-year survival rate highlights the poor prognosis of BCC with bone invasion and further underscores the importance of early detection and treatment.

Keywords: basal cell carcinoma; bone invasion; direct invasion; disease-free survival; disease-specific survival; overall survival; pooled survival analysis; risk factors; survival outcomes; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Carcinoma, Basal Cell* / pathology
  • Disease Progression
  • Humans
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / pathology
  • Skin Neoplasms* / pathology
  • Survival Analysis