Giant basal cell carcinoma masquerading as an osteogenic sarcoma

An 88-year-old man presented to the dermatology outpatient clinic with an 11-month history of a rapidly growing mass overlying a clavicular fracture site. The lesion was 8 x 6 cm, painful, fixed to deeper structures and ulcerated. Superficial and deep biopsies yielded invasive basal cell carcinoma. Imaging demonstrated extensive soft tissue invasion into muscle, bone and potentially into the lung parenchyma. Due to complications arising from subsequent diagnostic procedures, the patient declined further invasive tests. The cutaneous lesion was treated with palliative radiotherapy. We explore the literature regarding the tumorigenic effects of peri-fracture cytokines on the biological behaviour of basal cell neoplasms.