BackgroundMetastatic BCC (mBCC) is rare and there are limited data regarding patient and tumor risk factors, optimal treatments, and disease prognosis. ObjectiveTo assess patient and tumor characteristics, therapeutics, and outcomes of mBCC stratified by location of metastasis. MethodsRetrospective cohort study of fifty-three patients with mBCC treated at four large academic centers in Boston, Massachusetts; Philadelphia, Pennsylvania; and Cleveland, Ohio between January 1, 2005 to December 31, 2021. ResultsA total of 53 patients with mBCC were identified across 4 centers, 22 (42%) of whom had mBCC with spread limited to lymph nodes and 31 (58%) patients with distant organ spread (with or without lymph node involvement). Overall, half (n=11) of patients with nodal metastasis achieved complete remission of disease, compared to just 1 (3%) patient with distant metastasis. The 5-year survival for nodal and distant metastatic patients was 89.3% and 61.0%, respectively. LimitationsSmall sample size due to disease rarity Conclusions and RelevancePatients with nodal disease are more likely to have disease remission whereas patients with distant metastasis are more likely to have persistent disease and die from their disease. However, 5-year survival rates exceed 50%, even for stage IV disease.