Fungating Basal Cell Carcinoma of a Pacemaker Pocket: A Case Study and Review of the Literature

Abstract

Worldwide more than 250,000 pacemakers are implanted yearly. Tumors originating over pacemaker pockets have rarely been reported. We present the case of an 83 year old male with an invasive basal cell carcinoma involving a pacemaker pocket. A fungating tumor mass over the implant site had previously been managed as a chronic non-healing wound at a local wound center. Lack of clinical improvement led to a referral to our plastic surgery service where a Marjolin’s Ulcer was suspected. This in addition to concern for loss of the pacemaker pocket led to operative intervention. The mass was excised en bloc with the pacemaker pocket. The pacemaker was relocated into an ipsilateral subpectoral pocket after creation of a transmuscular channel for the defibrillator and pacemaker leads. Pathology of the lesion showed the presence of a basal cell carcinoma. To our knowledge, this is the first reported case of an ulcerative basal cell carcinoma invading a pacemaker pocket. In addition the pathophysiology, management and treatment strategies of pacemaker pocket tumors are reviewed and discussed.