Limb Salvage With Vismodegib in a High-Risk Marjolin Ulcer-Type Basal Cell Carcinoma of the Leg

Marjolin ulcer classically describes squamous cell carcinoma arising in chronic wounds, whereas basal cell carcinoma (BCC) transformation within a chronic venous ulcer is rarely reported.We describe an elderly woman with chronic venous insufficiency (CEAP 6) and a two-decade medial malleolar ulcer who developed nodular adenoid and trabecular BCC within the ulcer bed, alongside a synchronous, independent contralateral nodular adenoid BCC.Given her age, comorbidities, and suspected microvascular compromise, she was a poor candidate for excision with flap reconstruction; amputation was proposed and declined.She was started on oral vismodegib as limb-sparing therapy.Imaging showed stable disease without deep invasion, followed by ulcer resolution with cicatricial change and a biopsy negative for residual tumor.The contralateral BCC responded to topical imiquimod.Adverse effects were limited to alopecia, dysgeusia, and muscle cramps.This case highlights BCC as an underrecognized cause of Marjolin ulcer and supports vismodegib as an effective, well-tolerated limb-sparing alternative to amputation.