BASAL CELL CARCINOMA ARISING IN SCARS: LATE PRESENTATION 16 YEARS AFTER A MIDLINE STERNOTOMY

Invasive Lobular Cancer Arising in a Surgical Scar From Lumpectomy for a Previous Invasive Ductal Cancer of the Breast

We describe a case of pathology-proven invasive lobular breast cancer (ILC) arising in a scar over 15 years after lumpectomy for previous invasive ductal carcinoma (IDC). The tumor was detected on screening mammography as a new focal asymmetry at the scar site and confirmed at diagnostic mammography. Ultrasound demonstrated an irregular, shadowing, hypoechoic mass at the scar site. Ultrasound-guided biopsy revealed poorly differentiated invasive lobular carcinoma. MRI and CT showed an irregular mass with pectoralis muscle invasion. Multimodality imaging findings are described. This is the first case to our knowledge reporting multimodality imaging findings of a breast cancer developing at the site of a surgical scar that is histologically different from the originally resected cancer.

Breast cancer from the excisional scar of a benign mass

Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.

Basal cell carcinoma masquerading as a hallux valgus

The incidence of primary skin cancers of the foot is exceedingly low; conversely, problems associated with a hallux valgus are common. A nonhealing ulcer overlying a hallux valgus managed conservatively with ointments and orthotic adjustments, and even with skin grafts, did not resolve over a period of 10 years. Ultimately, a shave biopsy revealed that the lesion was a basal cell carcinoma. Wide local excision and another skin graft resulted in tumour eradication and, finally, healing. Basal cell carcinoma associated with a hallux valgus has not been previously reported, and this reinforces the concept that malignant degeneration as the cause of any chronic ulceration should not be overlooked.