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When metastasis occurs, it usually involves regional lymph nodes. BCC lesions located in the head and neck region have been shown to spread to cervical lymph nodes. Here, we present a case of a slow\u2010growing lesion on the scalp that was diagnosed as a case of BCC. Metastasis to the level V cervical lymph nodes was already present at the time of diagnosis. The patient was managed with complete excision of the lesion, along with a neck dissection for level V lymph nodes, and adjuvant chemotherapy with Vismodegib. Molecular pathology results revealed a unique pattern, comprising the fusion of HMGA2\u2010CHMP1A genes and a mutation involving a premature termination codon (PTC) in the CDKN2B gene. The post\u2010operative work\u2010up revealed a hypermetabolic nodule in level IIB lymph which is more likely inflammatory rather than metastatic. However, considering the possibility of metastasis, the patient is being followed up by a multi\u2010disciplinary team (MDT) for evaluation of level IIB cervical lymph nodes. This case highlights the diagnostic and therapeutic challenges that may arise in rare cases of BCC with metastasis.<\/jats:p>","DOI":"10.1002\/ccr3.71490","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T04:15:12Z","timestamp":1776053712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metastatic Basal Cell Carcinoma With Unusual Molecular Genetics Findings"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8588-2660","authenticated-orcid":false,"given":"Noora","family":"Al\u2010Hail","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Al\u2010Abdulla","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Hamad Medical 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