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Case Study: Basal Cell Carcinoma as a Nonhealing Lesion

By: Kayci Reyer
Posted: Tuesday, October 13, 2020

A case study published in The Journal of Vascular Access describes an occurrence of a nonhealing skin ulcer on an arteriovenous fistula that was eventually diagnosed as a basal cell carcinoma. Basal cell carcinoma, the most commonly occurring malignancy in humans, sometimes presents as an atypical cutaneous lesion known as a “malignant wound.”

“This case emphasizes the importance of finding alternative diagnoses in the presence of persistent ulcers with no apparent cause (ischemia, infection, etc.),” concluded Luis Angel Suárez González, MD, PhD, of the Hospital Universitario de León in Spain, and colleagues. “A high degree of suspicion is essential in nonhealing ulcers.”

The patient had a still-functioning brachiosaurus-cephalon native arteriovenous fistula on his left upper arm (from 10 years prior) and a history of heart disease, diabetes mellitus, hypertension, and polycystic kidney disease. Last used in relation to a kidney transplant that occurred 3 years before the case study, the fistula had developed an ulcer that was unresponsive to a weeks-long wound care regimen. The ulcer had an irregular border, a superficial crust, a hemorrhagic base, and exophytic growth.

Following the biopsy, a diagnosis of basal cell carcinoma was reached. Though basal cell carcinoma is rarely metastatic, it can result in destructive local tumor spread. This spread can cause high morbidity rates through the invasion of neighboring tissues and internal organs.

The patient was referred for surgery, during which the aneurysmal venous segment and tumor were removed. The patient was discharged following a favorable postoperative period.

Disclosure: The study authors reported no conflicts of interest.



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