A 69-year-old patient who underwent coronary artery bypass grafting (CABG) 10 years prior, presented with a sternal wire protruding through the skin in the middle of the sternotomy scar (Figure 1). The area surrounding the wound was inflamed and was initially treated with local therapy and antibiotics. A CT scan confirmed the absence of osteomyelitis. Despite this, there remained a persistent suspected nidus of infection with chronic ulceration, and thus excision was indicated.
Figure 1.
Ulcerated wound around the sternal wires twist (arrow).
Excision of the infected area was performed, and the two underlying wires were completely removed. The specimen was sent to microbiology for culture as well as pathology for histopathological examination.
A heavy growth of Staphylococcus aureus was identified on culture, and histopathology revealed a basal cell carcinoma (Figure 2). The patient was subsequently referred to Medical Oncology for management.
Figure 2.
Histopathology of excised wound revealed basal cell carcinoma, with nodular and micronodular components, and basosquamous infiltration with ulceration and positive margins.
Although malignancies of scar tissues including median sternotomy are rare, its transformation should be suspected in patients presenting late after surgery with unusual localized wounds. For those patients, wide local excision of the suspicious infected areas with histopathologic examination is recommended.
Footnotes
Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical approval: Not applicable.
Informed consent: Not applicable.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iD: Elsayed Elmistekawy https://orcid.org/0000-0001-7088-1614