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Ulcerated Basal Cell Carcinomas Masquerading as Venous Leg Ulcers
Catherine N Tchanque-Fossuo1, Jillian W Millsop, Mary Ann Johnson
1Catherine 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.
Basal cell carcinoma (BCC), a rare complication of venous leg ulcers (VLUs), was diagnosed via biopsy in four elderly male patients. Prompt biopsy of stalled VLU healing is crucial for early cancer detection and treatment.
Area of Science:
- Dermatology
- Oncology
- Wound Care
Background:
- Nonmelanoma skin cancers, including basal cell carcinoma (BCC), rarely develop from venous leg ulcers (VLUs).
- BCC is the most common nonmelanoma skin cancer, but its link to lower-extremity ulcers is less frequently documented than other malignancies.
Purpose of the Study:
- To present a case series of biopsy-proven BCC originating from lower-extremity ulcers.
- To highlight the importance of biopsy in diagnosing malignancy in chronic wounds.
Main Methods:
- Four elderly male patients with chronic VLUs presented to a wound clinic.
- Biopsies were performed on ulcerative lesions, followed by surgical excision and reconstructive procedures or secondary intention healing.
Main Results:
- Histologic examination confirmed BCC in all four patients.
- Surgical excision with either skin grafting or secondary intention led to healing in most cases.
- One patient with conservative management showed incomplete healing at follow-up.
Conclusions:
- Biopsies are recommended for VLUs with stalled healing after three months of standard care.
- Biopsies should be taken from both the base and periphery of the ulcer.
- This approach helps rule out various malignant transformations, including BCC, squamous cell carcinoma, sarcoma, melanoma, lymphoma, or metastases.
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