Giant verrucous carcinoma of the lower extremity in women with dementia

Abstract

SummaryWe present the case of an 81-year-old woman with dementia and a giant exophytic ulcerated tumour, which covered most of the lower leg and the dorsum of the foot and emitted a foul smell. The patient had chronic venous insufficiency for 30 years, and previously (appr. 20 years ago) had a squamous cell carcinoma in the same location (right lower leg) that could be treated surgically. The dermatopathological examination of a large excisional biopsy revealed a highly differentiated verrucous carcinoma (formerly referred to as papillomatosis cutis carcinoides). Pathologically modified lymph nodes (suspicious of lymphatic metastases) were observed. Possible treatment options (surgery, intralesional and systemic treatment) were discussed. Finally, due to extension, location of the tumour and the age and co-morbidities of the patient, a decision was made to perform radiation therapy. BACKGROUND

Verrucous Carcinoma of the Foot - Report of Two Cases

“…A histopathological verification on the line of resection should be mandatory (23). In inoperable cases, radiotherapy, retinoids, interferon-γ and photodynamic therapy can be efficient, but the number of such reports is limited, therefore they are not widely accepted (24,25,26). In severe cases when the bone tissue is affected, amputation is the main therapeutic modality (7,8,19).…”

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“…Concomitant diseases, such as cardiovascular problems, dementia, and metabolic disorders, hamper the implementation of treatment options for these patients. In particular, psychiatric disorders and dementia lead to neglect or the development of huge tumors and associated defacement . Anticoagulative medications also limit the performance of some surgical procedures.…”

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“…Other options include cryosurgery, topical chemotherapy (mostly based on cisplatin, 5-fluorouracil and imiquimod), electrocautery, and photodynamic therapy 3,5,15 . Radiation therapy for VC is controversial 2,8 .…”