Journal of Foot and Ankle Surgery
Volume 49, Issue 1 , Pages 75-79 , January 2010

Malignant Transformation of a Chronic Venous Stasis Ulcer to Basal Cell Carcinoma in a Diabetic Patient: Case Study and Review of the Pathophysiology

  • Molly Schnirring-Judge, DPM, FACFAS

      Affiliations

    • Faculty Graduate Medical Education, Mercy Hospital Health Systems, Toledo, OH; Director; Research and Publications, Kaiser Permanente, Cleveland, OH; Adjunct Clinical Faculty, Ohio University, Athens, OH
    • Corresponding Author InformationAddress correspondence to Molly S. Judge, DPM, FACFAS, 7581 Secor Road, Lambertville, Michigan 48144.
    • ,
  • Drew Belpedio, DPM

      Affiliations

    • PGY-III, St. Vincent Mercy Hospital, Mercy Hospital Health Systems, Toledo, OH

References 

  1. Fitzpatrick TB, Johnson RA, Polano MK, Suurmond D, Wolff K, eds. Basal Cell Carcinoma. In Color Atlas and Synopsis of Clinical Dermatology: Common and Serious Diseases, ed 2, pp. 690–695, McGraw-Hill, New York, 1983.
  2. Colvett KT, Wilson FC, Stanton RA. Atypical presentation of metastatic basal cell carcinoma. Southern Med J. 2004;97:305–307
  3. Giles GG, Marks R, Foley P. Incidence of non-melanocytic skin cancer treated in Australia. Br Med J (Clin Res Ed). 1988;296:13–17
  4. Phillips TJ, Salman SM, Rogers GS. Nonhealing leg ulcers: a manifestation of basal cell carcinoma. J Am Acad Dermatol. 1991;25:47–49
  5. Leis SB, Bayne O, Karlin JM, Scurran BL, Reiner M. Squamous cell carcinoma: an unusual early complication of postoperative osteomyelitis. J Foot Ankle Surg. 1994;33(1):21–27Erratum in J Foot Ankle Surg 33(3):323, 1994
  6. Patel DU, Rolfes R. Squamous cell carcinoma of the nail bed. J Am Podiatr Med Assoc. 1995;85(10):547–549
  7. Thul JR, Stone ML. Squamous cell carcinoma of the hallux. J Foot Surg. 1982;21(1):61–64
  8. Guadara J, Sergi A, Labruna V, Welch M, Gazivoda PL. Transformation of plantar verruca into squamous cell carcinoma. J Foot Surg. 1992;31(6):611–614
  9. Trent JT, Kirsner RS. Wounds and malignancy. Adv Skin Wound Care. 2003;16(1):31–34
  10. Kirsner RS, Spencer J, Falanga V, Garland LE, Kerdel FA. Squamous cell carcinoma arising in osteomyelitis and chronic wounds. Treatment with Mohs micrographic surgery vs amputation. Dermatol Surg. 1996;22(12):1015–1018
  11. Hansson C, Andersson E. Malignant skin lesions on the legs and feet at a dermatological leg ulcer clinic during five years. Acta Derm Venereol. 1998;78(2):147–148
  12. Lidell K. Malignant change in chronic varicose ulceration. Practitioner. 1975;215(1287):335–339
  13. Arons MS, Lynch JB, Lewis SR, Blocker TG. Scar tissue carcinoma. I. A clinical study with special reference to burn scar carcinoma. Ann Surg. 1965;161:170–188
  14. Gan BS, Colcleugh RG, Scilley CG, Craig ID. Melanoma arising in a chronic (Marjolin's) ulcer. J Am Acad Dermatol. 1995;32(6):1058–1059
  15. Fleming ID, Barnawell JR, Burlison PE, Rankin JS. Skin cancer in black patients. Cancer. 1975;35(3):600–605
  16. Ch'ng S, Wallis RA, Yuan L, Davis PF, Tan ST. Mast cells and cutaneous malignancies. Mod Pathol. 2006;19:149–159
  17. Ackroyd JS, Young AE. Leg ulcers that do not heal. Br Med J (Clin Res Ed). 1983;286(6360):207–208
  18. Trengove NJ, Stacey MC, Macauley S, Bennett N, Gibson J, Burslem F, et al. Analysis of the acute and chronic wound environment: the role of proteases and their inhibitors. Wound Rep Reg. 1999;7(6):442–452
  19. Marjolin JN. Ulcère. In:  Adelon NP editors. Dictionnaire de Médecine. Paris: Becher; 1828;p. 31–50
  20. Tenopyr J, Silverman I. The relation of chronic varicose ulcer to epithelioma: based on records of over 1,000 chronic leg ulcers. Ann Surg. 1932;95:754–758
  21. Baldursson B, Sigurgeirsson B, Lindelöf B. Venous leg ulcers and squamous cell carcinoma: a large-scale epidemiological study. Br J Dermatol. 1995;133:571–574
  22. Combemale P, Bousquet M, Kanitakis J, Bernard P. Malignant transformation of leg ulcers: a retrospective study of 85 cases. J Eur Acad Dermatol Venereol. 2007;21:935–941
  23. Yang D, Morrisson BD, Vandongen YK, Singh A, Stacey M. Malignancy in chronic leg ulcers. Med J Aust. 1996;164:718–720
  24. García-Hernández MJ, Pérez-Bernal AM, Camacho FM. Chronic leg ulcers: a manifestation of basal cell carcinoma. Surgical treatment. J Eur Acad Dermatol Venereol. 2004;18(4):513–514
  25. Aloi F, Tomasini C, Margiotta A, Pippione M. Chronic venous stasis: not a predisposing factor for basal cell carcinoma on the leg. A histopathological study. Dermatology. 1994;188:91–93
  26. Agullo FJ, Santillan AA, Miller WT. Image of the month: Marjolin ulcer. Arch Surg. 2006;141:1143–1144
  27. Chiang KH, Chou AS, Hsu YH, Lee SK, Lee CC, Yen PS, et al. Marjolin's ulcer: MR appearance. Am J Roentgenol. 2006;186(3):819–820
  28. Combemale P, Bousquet M, Kanitakis J, Bernard P. The angiodermatology group of the French Society of Dermatology malignant transformation of leg ulcers: a retrospective study of 85 cases. J Eur Acad Dermatol Venereol. 2007;21:935–941
  29. Taylor GW, Nathanson IT, Shaw DT. Epidermoid carcinoma of the extremities with reference to lymph node involvement. Ann Surg. 1941;113:268–275
  30. Karim R, Dutrieux R, Lassance F, Hage J. MMP-2 assessment as an indicator of wound healing: A feasibility study. Adv Skin Wound Care. 2009;19(6):324–327
  31. Weidmann A, Harkins K. What lies beneath? Assessment of leg ulcers during acute hospital admission. Age Ageing. 2008;37(1):117–118

 Financial Disclosure: None reported.

 Conflict of Interest: None reported.

PII: S1067-2516(09)00291-9

doi: 10.1053/j.jfas.2009.07.015

Journal of Foot and Ankle Surgery
Volume 49, Issue 1 , Pages 75-79 , January 2010

Article Tools

* Image Usage & Resolution