Squamous cell carcinoma arising in chronic osteomyelitis in foot and ankle

Squamous cell carcinoma arising from chronic osteomyelitis is uncommon, and although most occur in the lower extremities, occurrence in the foot and ankle is rare.

Between February, 1991, and May, 2003, we treated 14 patients (13 men and one woman) with squamous cell carcinomas arising in chronic osteomyelitis. The foot and ankle were affected in seven patients, and these comprised our study group. All seven patients were male, with a mean age of 59.5 (range 54 to 63) years. An average of 27 (range 4 to 50) years passed between draining of the osteomyelitis and the diagnosis of the malignancy. Average followup was 68 (22 to 147) months.

Six patients had amputations and one had limb salvage. Regional lymph node clearance was done in four patients, but metastasis occurred in only one patient who later died of the disease.

In treating recalcitrant ulcers that have not responded to conventional modes of therapy, malignancy should be ruled out and a biopsy done. The treatment of choice for squamous cell carcinoma is amputation. Routine regional lymphadenectomy at the time of amputation seems unnecessary, but regional lymphadenopathy persisting for 3 months after amputation warrants surgical intervention.