Chronic Pressure Ulcer Carcinomas

Ce, Stankard; Cw, Cruse; Ke, Wells; Karl, Richard C.

doi:10.1097/00000637-199303000-00014

Cited by 29 publications

(21 citation statements)

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“…[2][3][4] However, a carcinoma complicating a pressure ulcer developed in the distal extremity, as seen in the present case, is very rare. 11,12 The four hallmark clinical signs of malignant transformation of chronic wound, as reported by Esther et al, 13 are: (1) appearance of a mass; (2) new onset of pain; (3) a change in odor of the drainage; and (4) change in the character, volume, or appearance of the drainage. We observed bleeding from the wound and hyperkeratotic change in the present case.…”

Section: Discussionmentioning

confidence: 92%

Verrucous carcinoma of the foot from chronic pressure ulcer

et al. 2004

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Study design: This is a case report with literature review. Objective: To describe a case of verrucous carcinoma, a rare histopathologic type, complicating a chronic pressure ulcer of duration less than 3 years. Setting: The department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, USA Method: A 24-year-old African-American male with long-standing incomplete paraplegia visited the wound clinic due to a pressure ulcer that had lasted for more than 1 year on the medial side of the right foot. Despite conservative management for almost 2 years after the initial visit, the ulcer is suspected to have undergone malignant transformation. Histological study led to the diagnosis of verrucous carcinoma that necessitated transtibial amputation on the right foot. Result: The carcinoma developed within 3 years, which was a relatively short time period for a pressure ulcer to have undergone malignant transformation. The diagnosis of verrucous carcinoma has never been reported as carcinoma complicating a pressure ulcer. No evidence of local recurrence or distant metastasis was seen in postoperative 10 months. Conclusion:The possibility of malignant transformation should be kept in mind in cases of pressure ulcers that are unresponsive to treatment or that show morphological changes suspected to be cancerous. Furthermore, early detection and intervention increases the probability for successful outcome.

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Section: Discussionmentioning

confidence: 92%

Verrucous carcinoma of the foot from chronic pressure ulcer

et al. 2004

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“…Radiation therapy has been used as palliation and the response to systemic chemotherapy is generally poor. [2][3][4] This case demonstrates the necessity for rigorous and early surgical treatment with closure of chronic pressure sores to prevent malignant transformation. It is recommended that if a chronic pressure sore has been present for years, extensive biopsies should be taken to make sure that there has not already been malignant transformation that has not been suspected macroscopically.…”

Section: Discussionmentioning

confidence: 93%

“…The causes of malignant degeneration are unknown but have partly been attributed to chronic irritation of the wound and to prolonged attempt at wound healing. 4 Once carcinoma has developed, the survival rate is poor. For unknown reasons, especially in SCI patients 2 year mortality rates ranges between 67 and 80%.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Carcinoma in chronic ulcers, known as Marjolin's ulcer, is also seen in connection with chronic ulcers of other etiologies, for example, in chronic burn scars, chronic fistulating osteomyelitis, venous stasis ulcers, traumatic wounds, anal fistula and urethrofistulae. 1,2 The clinical course is usually rapid and fulminant with a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

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Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

Knudsen

Biering‐Sørensen

2007

Spinal Cord

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Study design: Case report. Objective: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure. Setting: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Methods and Results: A 22-year-old man sustained a fracture with luxation of the 5th and 6th cervical vertebrae and loss of sensory and motor function after a diving accident (complete C8 lesion). During initial hospitalization, he developed a sacral ulcer, which more or less persisted for 38 years, despite several attempts of surgical and conservative treatment. At this time, the ulcer was finally excised and the wound closed successfully. Two and a half years later, however, the ulcer recurred. Biopsies showed squamous cell carcinoma and computed tomography, and magnetic resonance imaging scans revealed a soft tissue process over the sacral and coccygeal bones and massive destruction of these bony structures. The patient died 11 months later, despite surgical and radiation treatment. Conclusion:The present case is unusual because, in spite of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies in longstanding chronic ulcers to procure early diagnosis and treatment.

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“…Es gibt verschiedene Hypothesen zur Pathogenese von Plattenepithelkarzinomen, die in chronischen Wunden entstehen. So wird zum Beispiel postuliert, dass verletzte Haut gegenüber Mutationen empfindlicher sein könnte und dass fibrotisches und avaskuläres Narbengewebe die Überwachung durch das Immunsystem beeinträchtigt, sodass zirkulierende Lymphozyten neoplastische Zellen nicht mehr erreichen und zerstören können . Auch die Induktion ruhender neoplastischer Zellen, bestrahlungs‐ oder toxininduzierte Veränderungen der Mitose und die Implantation epidermaler Zellen in die Dermis wurden als pathogenetische Faktoren vorgeschlagen .…”

Section: Einführungunclassified

Plattenepithelkarzinome in chronischen venösen Ulcera crurum. Daten aus dem deutschen Marjolin‐Register und Übersichtsdarstellung

Reich‐Schupke

Doerler

Wollina³

et al. 2015

J Deutsche Derma Gesell

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Zusammenfassung Hintergrund Das sekundäre Plattenepithelkarzinom (engl. squamous cell carcinoma, SCC) ist eine seltene Komplikation bei chronischem Ulcus cruris venosum. Über seine Pathophysiologie und den klinischen Verlauf ist bislang wenig bekannt. Das aktuelle Marjolin‐Register geht aus einer Initiative der Arbeitsgruppe „Wundheilung“ (AGW) der Deutschen Dermatologischen Gesellschaft (DDG) hervor und erfasst Fälle von aus venösen Ulcera hervorgehenden Plattenepithelkarzinomen mit dem Ziel der Beurteilung diagnostischer Merkmale. Patienten und Methoden Alle Mitglieder der AGW beantworteten Fragebögen über Patientenbasisdaten, Ulkusmerkmale und die durchgeführte Therapie. Ergebnisse Zwischen 2010 und 2013 wurden 30 Patienten (20 Frauen, 10 Männer) aus sechs tertiären Wundbehandlungseinrichtungen registriert. Das Durchschnittsalter betrug 76,17 Jahre. Die durchschnittliche Dauer der Ulcera crurum venosa vor Diagnose des Plattenepithelkarzinoms betrug 15,93 Jahre. Als auffällige Wundmerkmale wurden in erster Linie Schmerz (n = 3), Therapieresistenz (n = 27) und Fötor (n = 12) sowie ein klinisches Erscheinungsbild (n = 10) mit atypischer Morphologie, nodulärem Wundbett und Hypergranulation festgestellt. Schlussfolgerungen Atypische Morphologie oder verändertes Erscheinungsbild sowie Therapieresistenz trotz optimaler Versorgung (6–12 Wochen) sollten zum Anlass genommen werden, wenn nötig mehrere und serielle spindelförmige Biopsien zu entnehmen. Die Hauptrisikofaktoren für eine maligne Transformation sind das Patientenalter und die Ulkusdauer.

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Chronic Pressure Ulcer Carcinomas

Cited by 29 publications

References 0 publications

Verrucous carcinoma of the foot from chronic pressure ulcer

Verrucous carcinoma of the foot from chronic pressure ulcer

Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

Plattenepithelkarzinome in chronischen venösen Ulcera crurum. Daten aus dem deutschen Marjolin‐Register und Übersichtsdarstellung

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