When A Basal Cell Carcinoma Occurs On The Plantar Foot
Basal cell carcinoma is the most common form of skin cancer. Accordingly, these authors discuss the diagnosis of a basal cell carcinoma in a patient who initially presented with bilateral venous stasis wounds that were increasing in size.
Basal cell carcinoma accounts for approximately 80 percent of non-melanoma skin cancers.1 About 3.5 million new basal and squamous cell cancers occur each year with basal cell carcinoma making up the majority of these cancers.2 Basal cell carcinoma arises from the basal layers of the epidermis and its appendages. These tumors have low potential to metastasize but if they are not treated adequately, they can cause destruction to surrounding soft tissue and possibly bone.
The prevalence of BCC is highly associated with areas of prolonged exposure to sunlight, such as the face and scalp, with rare presentation on the palmar-plantar surfaces. Our report discusses an atypical presentation of a basal cell carcinoma lesion at the plantar aspect of a patient’s right foot that we excised. This case report reinforces the importance of never overlooking an atypical lesion or wound.
A 78-year-old Hispanic male, visiting from Puerto Rico, presented to the Trinitas Regional Medical Center for bilateral lower extremity venous stasis wounds. His medical history was significant for type 2 diabetes mellitus, hypertension, peripheral vascular disease and venous insufficiency. The patient said he had the wounds for several months and recently noticed the wounds had been increasing in size.
The physical examination revealed bilateral venous wounds extending medially and laterally, encompassing the legs and extending to the dorsal aspect of the metatarsophalangeal joints. The wounds had a fibrotic, lobulated base with irregular margins. There was no exposed bone or tendon, but the patient had significant serous drainage and malodor. In addition, we observed an unusually raised, papular lesion at the right first submetatarsal. The lesion, which measured 0.8 x 0.8 cm, had irregular borders and shades of brown and black discoloration. The patient denied trauma and was unaware of the lesion until the physical exam. There were no other similar lesions at any other location on the patient.
We took the patient to the operating room for debridement of bilateral venous stasis wounds and simultaneously performed an incisional biopsy of the suspicious lesion. We sent the biopsy specimen (measuring 0.6 cm x 0.5 cm x 0.5 cm) to pathology. Three days later, the pathology report confirmed the biopsied specimen to be basal cell carcinoma.
At this point, we decided that a wide excision of the lesion would be the best course of treatment. Utilizing 5 cc of a 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain, we ensured the use of local anesthesia at the peripheral margins of the lesion located at the right first submetatarsal. Using a #15 blade, we performed a wide excision (2.2 cm x 1cm with a depth of 0.6 cm), ensuring total eradication of the cancerous lesion, and subsequently did a primary closure of the surgical site with a 3.0 nylon suture. We tagged the excised lesion with a 2.0 nylon suture at 12 o’clock and sent it to pathology. The pathology report confirmed the margins of the specimen to be clear of cancerous cells.