Supplementary Material for: Horrifying Basal Cell Carcinoma Presenting As Progressive Pyoderma Gangrenosum

This article reports a case of a 70-year old male, with a 17-year history of expanding pretibial skin ulcer, presumed by prior care providers to be pyoderma gangrenosum. A surgical biopsy performed upon presentation to our institution identified the ulcer to be a basal cell carcinoma of the skin which had invaded the proximal tibia with associated deep infection. Management of the malignancy required transfemoral amputation. This case report is written to increase awareness and encourage providers to establish certain diagnoses sooner, or reconsider diagnosis if management efforts do not achieve improvement. Earlier biopsy and management of this lesion when it was smaller and likely less invasive may have allowed a less severe surgical intervention and preserved limb function.