Basal Cell Carcinoma Arising in Venous Ulcers and Mimicking Granulation Tissue

BACKGROUND: Basal cell carcinoma (BCC) arising in venous ulcers is rare, and its appearance in this setting is not fully recognized. OBJECTIVE: The purpose of this report is to alert the clinician to the subtle clinical appearance of this tumor and to prompt a more rapid recognition. METHODS: We report five cases of BCC arising in venous ulcers of the lower extremity that we have observed over a period of 6 years. In all cases the tumor was diagnosed histologically. RESULTS: In all five cases the tumor had the appearance of seemingly healthy granulation tissue, which was often exuberant and translucent. The border of this apparent "granulation tissue" was rolled over the margins of the ulcer. CONCLUSION: Basal cell carcinoma arising in venous ulcers often has the appearance of translucent granulation tissue that extends beyond the ulcer's margins. These clinical characteristics should alert the clinician to the need for obtaining a biopsy of the ulcer bed.