Basal Cell Carcinoma Involving a Ventriculoperitoneal Shunt: Case Report and Literature Review

Abstract

Ventriculoperitoneal shunts (VPSs) are commonly used for the management of raised intraventricular pressure, especially in the context of hydrocephalus. Malignant invasion involving a VPS is an exceedingly rare association, only reported three times in the literature to date. We present the involvement of a VPS with a recurrent basal cell carcinoma (BCC), which has not been described previously. It was theorized that previously breached tissue planes associated with the VPS tract might facilitate local spread of the BCC. As such, this case represented an exceedingly rare association that has important conceptual implications for definitive surgical management. A 51-year-old paraplegic man with spina bifida and hydrocephalus, who had been immunosuppressed for 7 years following a renal transplantation, presented to our clinic with a recurrent BCC involving an inactive VPS in the right neck. Surgical management involved an excision of the scar with a peripheral margin of 1 cm, along with removal of the involved shunt tract and intraoperative pathologic assessment. Definitive histopathology revealed a focus of infiltrating sclerosing BCC involving the subcutaneous tissue and abutting the VPS. As the scope for synthetic materials in surgery continues to expand, so does the multitude of interesting complications that appear to arise from interactions between host tissue and foreign bodies. This case report describes a fascinating relationship between a recurrent BCC and a VPS, providing a guide for future management to ensure adequate surgical clearance. The case would be of interest to head/neck surgeons, neurosurgeons, and plastic surgeons.