Horrifying Basal Cell Carcinoma Presenting as Progressive Pyoderma Gangrenosum: Case Report

Area of Science:

• Dermatology
• Oncology
• Surgical Pathology

Background:

• Skin ulcers present diagnostic challenges, especially with autoimmune and gastrointestinal comorbidities.
• Occam's razor is a principle for diagnosis, but must be reconsidered when interventions are ineffective.

Observation:

• A 70-year-old male had a 17-year history of a pretibial skin ulcer.
• Previous providers diagnosed the ulcer as pyoderma gangrenosum, potentially related to Crohn's disease.

Findings:

• Surgical biopsy revealed invasive basal cell carcinoma of the skin with deep infection.
• The diagnosis necessitated transfemoral amputation.

Implications:

• This case underscores the need to re-evaluate diagnoses when patient conditions worsen despite treatment.
• Prompt diagnosis is crucial for effective limb salvage and patient outcomes.