Positron emission tomography for basal cell carcinoma of the head and neck

Objective: To determine the ability of fluorodeoxyglucose F 18 positron emission tomography (FDG-PET) to image basal cell carcinoma (BCC). Design: Case series study. Setting: Mohs surgery practice in a tertiary university hospital. Patients: Six patients with BCC larger than 1.0 cm of the head and neck region were identified. Results: Patients were imaged using FDG-PET before surgery. In 3 patients, PET imaging correlated well with the size and extent of the soft tissue invasion. Histologically, all 3 tumors were of the nodular subtype. The remaining 3 patients failed to demonstrate identifiable tumor activity on PET. Two of these 3 tumors were of the infiltrative histologic subtype, and 1 was of the nodular subtype. Perineural spread was detected by tissue biopsy in 1 infiltrative tumor, but not by FDG-PET imaging. Conclusions: In our study, FDG-PET imaging was able to image and identify BCC in the head and neck region in 3 of 6 patients. In some cases, anatomic accuracy and the extent of soft tissue invasion were observed. The histologic subtype of the BCC appears to affect the ability of FDG-PET detection, with the nodular histologic subtype more likely to test positive on PET. This is a preliminary study, and future investigation is needed to evaluate the role of PET imaging in the management of patients with BCC.