A Clinical Case of a Chronic Leg Ulcer Progressing to Infiltrative Basal Cell Carcinoma of the Skin

Introduction Chronic wounds, due to their characteristics, have the tendency of developing malignancy which may lead to invasive basal cell carcinoma. [1]. However, their progression to infiltrative basal cell carcinoma is an exceedingly rare phenomenon [2]. Deeper tissues invasion, such as the bone or periosteum, by infiltrative basal cell carcinoma is an uncommon occurrence and is associated with poor clinical outcomes and increased complexity in clinical management requiring multifaceted therapeutic approaches [3]. Case Presentation This case presents a 79-year-old woman who suffered from non-healing leg ulcers for many years, they grew larger and became painful over time. Biopsy revealed infiltrating basal cell carcinoma, and MRI of the leg revealed tumor cell infiltration into the tibial periosteum. Due to age and reluctance, radical surgery was refused. Biological therapy with vismodegib was prescribed, leading to tumor regression and ulcer reduction, this was followed by ulcer excision and autodermoplasty. A year later, the small ulcer recurred, and radiation therapy eliminated tumor cells. Longterm local treatment with innovative dressings and negative pressure therapy was required. Discussion Chronic ulcers rarely progress to malignancies, such as basal cell carcinoma, but this can occur because of prolonged inflammation and tissue damage, highlighting the need for frequent checkups and early histopathological assessment. Biopsy is the gold standard for diagnosis, recommended if chronic wound failed to heal after 3 – 4 months of reasonable treatment [5]. Management requires a multidisciplinary approach, including surgical removal, advanced wound care, oncologist consultation, and follow-up [4]. Amputation is indicated for deep invasion to bone or when wide excision would cause functional disability. In our case, however, the correct decision of the multidisciplinary team allowed a more conservative treatment and good control of the disease. Conclusions This unique case highlights the potential for chronic ulcers to progress to malignancies, showing how important close follow up and early histopathology is. This case demonstrates the effectiveness of a multidisciplinary approach. In this and similar clinical situations, efficient treatment and individualized management are essential.