Track: Case Reports

Abstract:

Basal cell carcinoma (BCC), though microscopically distinctive, can rarely mimic inflammatory dermatoses such as pyoderma gangrenosum (PG), complicating clinical diagnosis and delaying appropriate treatment if biopsy is not performed early. We report a case of a 72-year-old male with a history of diverticulitis, type 2 diabetes, and chronic kidney disease who presented with an 8-year history of a non-healing ulcer measuring 23 x 20 cm with a slightly raised gray to violaceous border nearly encircling the left lower leg. The lesion was initially diagnosed clinically as infectious and later as PG, prompting multiple antibiotic and immunosuppressive regimens. Due to lack of improvement, a biopsy was performed and revealed infiltrative BCC. Plans were made for treatment with sonidegib to reduce tumor size prior to surgery. This case underscores the risks of diagnostic momentum and the reluctance to biopsy PG-suspected lesions due to concerns over pathergy. Histopathology is essential for diagnosis of PG, the presence of neutrophils at an ulcer’s edge being the sole major criteria. Due to its broad differential diagnosis, including infection and malignancy, early biopsy is advisable. This case illustrates the critical role of timely histopathological assessment in atypical or nonresponsive ulcerations and highlights an unusual presentation of basal cell carcinoma which has only rarely been described in the literature. Early biopsy could have avoided prolonged ineffective therapy, reduced patient morbidity, and expedited appropriate oncologic intervention.

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Amy Flischel