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Ulcerated Basal Cell Carcinomas Masquerading as Venous Leg Ulcers

Tchanque-Fossuo, Catherine, N., MD, MS; Millsop, Jillian, W., MD, MS; Johnson, Mary, Ann, MD, MS; Dahle, Sara, E., DPM, MPH; Isseroff, R., Rivkah, MD

Advances in Skin & Wound Care: March 2018 - Volume 31 - Issue 3 - p 130–134
doi: 10.1097/01.ASW.0000530068.44631.dc
Features: Case Series

BACKGROUND: Nonmelanoma skin cancers rarely arise from venous leg ulcers (VLUs). Although basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer, its association with lower-extremity ulcers is not as frequently reported as other malignancies.

OBJECTIVE: To report a case series of biopsy-proven BCC from lower-extremity ulcers of patients who presented at a multispecialty wound clinic.

METHODS: Four male patients (mean age, 82.75 years) with 4 chronic VLUs (duration ranging from 2 months to 10 years) underwent a biopsy of their ulcerative lesions.

RESULTS: Histologic examination of the specimens revealed 4 cases of BCC. All of the lesions were surgically excised, followed by split-thickness skin graft (n = 2) or healing by secondary intention (n = 2). All of the patients remained healed at follow-up ranging from 15 to 27 months, except for 1 patient who opted for conservative management and had not completely healed at 14 months’ follow-up.

CONCLUSIONS: Biopsies are warranted for any VLU with documented stalled healing following 3 months of standard of care. One biopsy is performed at the periphery of the ulcer and another at the base in order to rule out the presence of malignant transformation because of BCC, squamous cell carcinoma, sarcoma, melanoma, lymphoma, or metastases.

Catherine N. Tchanque-Fossuo, MD, MS, is a Clinical Wound Fellow, at both the Department of Dermatology, University of California Davis, Sacramento, and the Dermatology Service, VA Northern California Health Care Systems, Mather, California. Jillian W. Millsop, MD, MS, is a Dermatology Resident, Department of Dermatology, University of California Davis, Sacramento, California. Mary Ann Johnson, MD, MS, is a Dermatologist, Mercy Medical Group-Dignity Health, El Dorado Hills, California. Sara E. Dahle, DPM, MPH, is Chief, Podiatry Section, Department of Surgery, VA Northern California Health Care Systems, Mather, and Assistant Professor, Department of Dermatology, University of California Davis, Sacramento, California. R. Rivkah Isseroff, MD, is Chief, Dermatology Service, VA Northern California Health Care Systems, Mather, and Professor, Department of Dermatology, University of California Davis, Sacramento, California. The authors have disclosed they have no financial relationships related to this article. Submitted January 15, 2017; accepted in revised form October 27, 2017.

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