Malignant transformation of a chronic leg ulcer: a case report / Maligna alteracija hronične venske ulceracije na podkolenici: prikaz slučaja

Abstract

Squamous cell carcinoma (SCC) is a malignant tumor of epidermal keratinocytes which may arise de novo, or at already affected skin areas of different etiology, including chronic vascular ulcers (CVUs). We present a 74-year-old female patient, hospitalized in the Department of Dermatology, with venous ulceration of the lower right leg, 10x5 cm in size, with well-demarcated edges, and the base covered with fibrin and granulation tissue. The ulceration appeared 7 years ago, while 3 years ago it spread rapidly with pain in the right lower leg. In the beginning, the patient was treated with local and systemic antibiotic therapy. Later, hydrocoloid dressings and compressive bandages were applied, and after that hyperoxygenation was performed in the hyperbaric chamber. Although the above-mentioned therapy was applied correctly, it was not efficient. Since malignant alteration was suspected, two biopsies were taken and in both, histopathologic analysis showed granulation tissue without dysplasia. The third biopsy, however, performed a month after the second one, revealed a squamous cell carcinoma. After further investigations, amputation of the right lower leg was suggested. Therefore, in cases with extended CVUs without no adequate therapeutical response during a long period of time, malignant transformation should be considered, and multiple biopsies at various sites should be performed.