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We reviewed clinicopathologic features of 22 patients with metastasizing basal cell carcinoma (MBCC). Immunohistochemical markers of EMT, including CD44, E\u2010cadherin, claudin, smooth muscle actin, beta\u2010catenin, Twist1, and Oct 3\/4, were evaluated on 10 MBCC (primary and metastases) and 18 non\u2010metastasizing BCC. Primary sites included the head and neck, trunk, and extremity, while metastatic sites included lymph nodes, lung, bone, and soft tissue. Of 19 cases with follow\u2010up, the range of follow\u2010up after diagnosis of metastasis was 5 to 248\u2009months (median: 50\u2009months). Two cases were of unknown primary, nine metastases were diagnosed concurrently with primary tumors, and remaining cases showed a median latency between diagnosis of primary and metastatic tumors of 27.5\u2009months (range: 3\u201081\u2009months). Median survival was 66\u2009months. Compared to non\u2010metastasizing BCC, MBCC demonstrated reduced CD44 expression (primary [<jats:italic>P<\/jats:italic> = .0036], metastatic [<jats:italic>P<\/jats:italic> = .011]) and increased Twist1 expression (primary, <jats:italic>P<\/jats:italic> = .0017). MBCC shows variably aggressive behavior, and reduced CD44 and increased Twist1 expression may indicate significant EMT in metastasizing tumors and signify a metastatic phenotype.<\/jats:p>","DOI":"10.1111\/cup.13888","type":"journal-article","created":{"date-parts":[[2020,10,3]],"date-time":"2020-10-03T14:46:17Z","timestamp":1601736377000},"page":"374-383","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Metastasizing basal cell carcinoma: A clinicopathologic and immunohistochemical study of 22 cases"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7306-8813","authenticated-orcid":false,"given":"Mark C.","family":"Mochel","sequence":"first","affiliation":[{"name":"Department of Pathology Virginia Commonwealth University School of Medicine  Richmond Virginia USA"},{"name":"Department of Dermatology Virginia Commonwealth University School of Medicine  Richmond Virginia 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