Malignant tumours arising in chronic leg ulcers: three cases and a review of the literature

Abstract

The precancerous potential of chronic leg ulcers is well-established but the number of reported cases overall is small. Delay in diagnosis may result in a worse prognosis, loss of the affected limb or occurrence of metastases. We report a case series of three patients with long-standing history of recalcitrant leg ulcers, which finally showed malignancy when histologically investigated. In addition, we discuss the literature concerning malignant transformation of chronic leg ulcers and try to bring forward the controversial question of how to differentiate primary and secondary malignancies in chronic ulcers. Although hypotheses about altered wound healing mechanisms, influence of chronic inflammation and irritation or tissue damage through infections are conclusive, further investigations are necessary to clarify the exact pathogenetic mechanisms of tumour development in chronic wounds.

Ten years of experience in chronic ulcers and malignant transformation

“…Malignant transformation is a rare and often misdiagnosed complication that conveys an ominous prognosis. Delay in diagnosis may result in a worse prognosis, loss of the affected limb or occurrence of metastases . In the majority of these cases, the malignancy consists of a rare, but highly aggressive, squamous cell carcinoma (SCC), generally located on the lower limbs.…”

Squamous cell carcinomas in chronic venous leg ulcers. Data of the German Marjolin Registry and review

“…As a general rule, any changes in clinical appearance and symptoms should always prompt diagnostic reevaluation . Here, biopsy and histologic differentiation are necessary to confirm or exclude malignancy .…”

“…Generell gilt, dass jedwede Veränderung des klinischen Erscheinungsbildes und der Symptome stets eine erneute diagnostische Abklärung veranlassen sollte [ 31 ] . Dabei sind Biopsienahme und histologische Differenzierung nötig, um eine maligne Erkrankung zu bestätigen oder auszuschließen [ 32 ] .…”

Eccrine porocarcinoma mimicking a venous leg ulcer

“…Other symptoms such as abnormal bleeding or unusual pain can confirm the suspicion of malignant origin of the ulcer. Prior injuries, burn scars or recurrent infections can additionally provide malignant transformation of preexisting vascular ulcers (7). EPC clinically presents as a slow-growing painless nodule or infiltrated plaque; squamous cell carcinoma, Merkel cell carcinoma and cutaneous lymphoma are included among the differential diagnoses.…”