A RARE CASE OF EXTENSIVE BASAL CELL CARCINOMA WITH INVASION OF THE HUMERUS: EXCISION AND IMMEDIATE RECONSTRUCTION WITH FIBULA ALLOGRAFT, PLATING, AND LATISSIMUS DORSI FLAP

Objectives: Basal cell carcinoma (BCC) is the most common skin cancer, presenting most commonly on the head and neck. BCC is also highly locally aggressive and can extend into bone with most reports involving the skull and facial bones. However, a diameter greater than 10cm or invasion into long bones is extremely rare. This report documents the case of a 73-year-old female presenting with an extensive BCC of the right arm. Magnetic Resonance Imaging (MRI) suggested cortical involvement of the right anterolateral humerus with periosteal elevation. Computed Tomography (CT) showed no evidence of distant metastasis. Incisional biopsy confirmed BCC Nodular type. The patient underwent excision of the malignancy with sufficient margins, including hemicortical excision of the humerus. Reconstruction included a fibula allograft, plating, and finally a latissimus dorsi flap with split-thickness skin graft for primary closure. Excluding a transient radial nerve palsy, the patient’s postoperative course was otherwise uncomplicated. Pathological examination confirmed the absence of malignancy on excisional margins. Although BCC invasion of long bone is extremely rare, the gold standard treatment is, as a rule, en bloc surgical resection with a wide variety of reconstructive techniques. This treatment is only possible through the collaboration of general surgery, orthopedic oncology, and plastic surgery. In the context of these rare tumors, we believe publicizing these cases and their treatments would be very beneficial to the scientific community as a whole.

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