Multiple basal cell carcinomas of lower legs with stasis dermatitis: a therapeutic challenge

Basal cell carcinoma (BCC) is the most common cancer found in humans. It has several clinical appearances, among which nodular and superficial types are the most common forms. Nodular BCC appears mostly in head and neck regions, while its occurrence in lower legs is extremely rare. A case is presented of a 94-year-old patient diagnosed with multiple recurrent BCCs of lower legs with concomitant longstanding venous insufficiency and severe hypostatic alterations of the surrounding skin. Treatment of multiple BCCs of lower legs was a challenge because of its rarity, therapeutic resistance, and patient comorbidity. All available therapeutic modalities for non-melanoma skin cancer were applied. Epidermal malignant tumors in lower legs were treated with surgery, photodynamic therapy with aminolevulinic acid (ALA-PDT), cryotherapy, and chemotherapy with 5-fluorouracil (5-FU). Because of the extensiveness of tumors and chronic venous insufficiency, surgery and radiotherapy were not considered as favorable therapeutic modalities for the treatment of tumors on the extensor aspects of lower legs, consequently other non-surgical modalities were applied. In this case, topical therapy with 5-FU proved to be superior to ALA-PDT and cryotherapy in the treatment of nodular BCCs of lower legs.