Malignant transformation of leg ulcers: a retrospective study of 85 cases

Background  Malignant transformation remains a rare, under‐recognized and ominous, complication of leg ulcers, although its exact prevalence is unknown. Patients and methods  This retrospective French study included cases of chronic ulcers of vascular origin complicated by histologically proven carc...

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Published in:Journal of the European Academy of Dermatology and Venereology 2007-08, Vol.21 (7), p.935-941
Main Authors: Combemale, P, Bousquet, M, Kanitakis, J, Bernard, P
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Amputation
basal cell carcinoma
Carcinoma, Basal Cell - epidemiology
Carcinoma, Basal Cell - pathology
Carcinoma, Basal Cell - surgery
Carcinoma, Squamous Cell - epidemiology
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Cell Transformation, Neoplastic
Female
France - epidemiology
Humans
leg ulcer
Leg Ulcer - epidemiology
Leg Ulcer - pathology
Leg Ulcer - surgery
Male
malignant transformation
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Retrospective Studies
skin cancer
Skin Neoplasms - epidemiology
Skin Neoplasms - pathology
Skin Neoplasms - surgery
squamous cell carcinoma
Surveys and Questionnaires
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Summary:Background  Malignant transformation remains a rare, under‐recognized and ominous, complication of leg ulcers, although its exact prevalence is unknown. Patients and methods  This retrospective French study included cases of chronic ulcers of vascular origin complicated by histologically proven carcinomas. For squamous cell carcinomas (SCC), the duration of the ulcer had to be longer than 3 years. For basal cell carcinomas (BCC), a negative previous biopsy of the ulcer was considered. Results  Eighty patients, accounting for 85 tumours, were included, with a female : male ratio of 2.5 : 1 and a mean age of 75 years. Eighty‐eight percent of the ulcers were of venous origin and their mean duration was 27.5 years. Five patients developed bilateral cancers. Clinical findings included abnormal granulation tissue in 76% of cases, absence of healing in 14% and unusual extension in 6%. Histologically, 83/85 (98%) of tumours were SCC, among which 82% were very well or well differentiated and 18% moderately or poorly differentiated. The two remaining cases were BCC. The overall death rate was 32%; it was higher when lymph‐node (66%) or visceral metastases (83%) were present. Leg amputation was performed in 29/51 (57%) of patients, irrespective of the degree of histological differentiation. For well‐differentiated (grade I) and localized (stage Ia) SCC, simple surgical excision was preferred to amputation. Conclusion  Malignant transformation of chronic leg ulcers of vascular origin is mainly encountered in elderly patients and manifests as an abnormally vegetating lesion, which may be occasionally bilateral. Malignant transformation usually occurs towards well‐differentiated SCC and only exceptionally towards BCC. The high death rate, especially in metastatic cases, is at least partly due to delay in diagnosis. Surgery remains the treatment of choice. Leg amputation should be considered in the most extensive cases.
ISSN:0926-9959
1468-3083
DOI:10.1111/j.1468-3083.2006.02118.x